Abstract Number: PB0431
Meeting: ISTH 2020 Congress
Theme: Diagnostics and OMICs » Biomarkers of Thrombosis and Hemostasis
Background: Chronic kidney disease (CKD) confers both increased bleeding and thrombotic risks in addition to traditional cardiovascular risk factors. Global coagulation assays (GCA) may advance our understanding of the individual’s haemostatic profile beyond standard coagulation tests.
Aims: To evaluate GCA in CKD patients compared to healthy controls.
Methods: In this prospective observational study, CKD subjects were recruited into 2 groups: eGFR< 30ml/min/1.73m2 (pre-dialysis) (n=24) and dialysis patients (n=51 including 40 haemodialysis and 11 peritoneal dialysis). The results were compared to healthy controls (n=153). Blood samples were collected for baseline investigations and GCA including whole blood thromboelastography (TEG5000) and platelet-poor calibrated automated thrombogram (CAT) and overall haemostatic potential (OHP).
Results: Compared to controls (mean age 42 years, 64% female, eGFR 101), CKD subjects (mean age 66 years, 39% female, eGFR 12) had increased von Willebrand factor (vWF) antigen, factor VIII level and D-dimer (Table 1). CKD patients showed hypercoagulable parameters compared to controls – increased maximal amplitude (MA) (p< 0.001) on thromboelastography and thrombin generation (peak thrombin p=0.015, velocity index p=0.002) with impaired overall fibrinolytic potential (OFP) (p< 0.001). Elevated urea did not predict hypocoagulability. Comparison of pre-dialysis and dialysis subpopulations did not identify significant differences for TEG and OHP parameters but dialysis patients, interestingly, demonstrated reduced thrombin generation (peak thrombin 232 vs 269 nM; p=0.046, velocity index 78 vs 103 nM/min; p=0.030) despite higher TFPI levels (59.2 vs 35.6 ng/mL; p=0.032). Peritoneal dialysis patients showed higher peak thrombin (279.9 vs 218.6 nM; p=0.007) and velocity index (104.6 vs 71.3 nM/min; p=0.014) with comparable MA and OFP compared to haemodialysis patients.
Conclusions: CKD appears to confer a hypercoagulable state with impaired fibrinolytic potential. Interestingly, dialysis patients demonstrated reduced thrombin generation compared to pre-dialysis patients but comparable to controls despite higher TFPI levels. Further longitudinal studies evaluating GCA and clinical outcomes in renal patients are required.
| Controls (n=153) | CKD (n=75) | p-value | |
| Factor VIII (%) | 115.7 | 194.5 | <0.001 |
| von Willebrand factor antigen (%) | 114.5 | 206.0 | <0.001 |
| D-dimer (ng/mL FEU) | 286 | 1145 | <0.001 |
| Maximum amplitude (mm) | 60.2 | 69.0 | <0.001 |
| Endogenous thrombin potential (nM.min) | 1335.1 | 1314.4 | 0.566 |
| Peak thrombin (nM) | 219.7 | 244.0 | 0.015 |
| Velocity index (nM/min) | 69.5 | 86.6 | 0.002 |
| Overall fibrinolytic potential (%) | 50.2 | 41.0 | <0.001 |
| Tissue factor pathway inhibitor (ng/mL) | 21.5 | 51.1 | <0.001 |
[Table 1 shows the comparisons between normal controls and patients with CKD]
To cite this abstract in AMA style:
Lim HY, Lui B, Barit D, Nandurkar H, Ho P. Global Coagulation Assays in Patients with Chronic Kidney Disease [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/global-coagulation-assays-in-patients-with-chronic-kidney-disease/. Accessed September 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/global-coagulation-assays-in-patients-with-chronic-kidney-disease/