Related Experiment Video
Updated: May 30, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Variability in Coagulation Profiles in Patients with Chronic Kidney Disease and Peripheral Artery Disease
Isabella Ferlini Cieri1, Shiv Patel1, Adriana A Rodriguez Alvarez1
1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Insights
Patients with declining kidney function show increased blood clot strength and fibrinogen levels, indicating a hypercoagulable state. However, these laboratory findings did not lead to more clinical bleeding or thrombotic events.
Area of Science:
- Nephrology
- Hematology
- Cardiovascular Medicine
Background:
- Chronic Kidney Disease (CKD) is linked to a prothrombotic state, affecting hemostasis via altered platelet function and coagulation.
- Traditional coagulation tests offer limited insight into these complex changes in CKD patients.
- Thromboelastography (TEG) provides a comprehensive assessment of clot formation dynamics, valuable for evaluating coagulation in CKD.
Purpose of the Study:
- To evaluate and compare coagulation profiles across different Glomerular Filtration Rate (GFR) categories in patients undergoing revascularization.
- To utilize Thromboelastography (TEG) for a detailed analysis of clotting dynamics in relation to kidney function.
- To investigate the impact of varying GFR levels on key hemostatic parameters.
Main Methods:
- Prospective evaluation of 254 patients with peripheral artery disease undergoing revascularization (December 2020-2023).
- Patients stratified into three GFR groups: >60 mL/min, 30-59 mL/min, and <30 mL/min.
- Pre-surgical blood samples analyzed using TEG parameters (Maximum Amplitude, Citrated Functional Fibrinogen, Functional Fibrinogen Levels); Kruskal-Wallis tests used for statistical analysis.
Main Results:
- Declining kidney function correlated with progressively higher TEG parameters, including Maximum Amplitude (MA) and Citrated Functional Fibrinogen (CFF) levels.
- Elevated fibrinogen levels (CFF FLEV) and clot strength (MA) were observed with lower GFR, indicating increased hypercoagulability.
- Patients on mono antiplatelet therapy (MAPT) exhibited higher coagulation markers than those on dual antiplatelet therapy (DAPT), especially in severe CKD.
Conclusions:
- Decreased kidney function is associated with relative hypercoagulability, characterized by elevated fibrinogen and stronger clot formation.
- While DAPT reduced coagulation markers compared to MAPT, platelet reactivity was similar across GFR categories.
- Despite laboratory evidence of hypercoagulability, no significant differences in clinical bleeding or arterial thrombotic events were observed across GFR categories.
Background:
Chronic Kidney Disease (CKD) has been associated with a prothrombotic state. CKD affects hemostasis through altered platelet function and coagulation factors. Traditional tests provide limited insight into these changes. We used Thromboelastography (TEG) to evaluate coagulation profiles in CKD and non-CKD patients, comparing parameters based on glomerular filtration rate (GFR) to better understand clotting dynamics. The aim of the study was to evaluate coagulation profiles in patients across GFR categories using Thromboelastography (TEG), which enables comprehensive assessment of clot formation dynamics.
Methods:
We prospectively evaluated patients with peripheral artery disease undergoing revascularization (December 2020-2023). Patients were stratified by GFR into 3 groups: >60 mL/min, 30-59 mL/min, and <30 mL/min. Pre-surgical blood samples were analyzed using TEG parameters, including Maximum Amplitude (MA), Citrated Functional Fibrinogen (CFF), and Functional Fibrinogen Levels (FLEV). Statistical analysis employed Kruskal-Wallis tests.
Results:
Among 254 patients (182 with GFR >60, 56 with GFR 30-59, and 16 with GFR <30), those with declining kidney function showed progressively higher values in CRT MA (62.80 vs. 65.85 vs. 67.85 mm, P = 0.0021), CK MA (61.10 vs. 64.00 vs. 66.70 mm, P = 0.0063), CFF MA (21.40 vs. 24.10 vs. 33.70 mm, P = 0.0017), and CFF FLEV (390.5 vs. 487.2 vs. 556.6 mg/dL, P = 0.0029). This pattern persisted in patients on mono antiplatelet therapy (MAPT). Patients receiving MAPT showed consistently higher coagulation marker levels compared to those on dual antiplatelet therapy (DAPT), particularly in severe renal impairment (GFR <30).
Conclusion:
Patients with decreased kidney function demonstrated relative hypercoagulability compared to those with normal kidney function, as evidenced by elevated fibrinogen levels and stronger blood clots. While DAPT was associated with lower coagulation marker levels compared to MAPT, platelet reactivity remained similar across GFR categories. However, these laboratory findings did not translate into increased clinical events, with no significant differences in bleeding episodes (P = 0.436) or arterial thrombotic events (P = 0.095) across GFR categories.
Related Concept Videos
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...