Abstract: SA-PO1003
Global Coagulation Assay Changes in Hemodialysis Patients
Session Information
- Hypertension and CVD: Mechanisms - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1403 Hypertension and CVD: Mechanisms
Authors
- Barit, David, Northern Health, Melbourne, Victoria, Australia
- Ho, Prahlad W., Northern Health, Melbourne, Victoria, Australia
- Lim, Yin H., Northern Health, Melbourne, Victoria, Australia
Background
Chronic kidney disease (CKD), and hemodialysis in particular, is thought to be a hypercoagulable state, which may contribute to increased cardiovascular risks. Given the limitations of current available coagulation testing in assessing thrombotic risks, we aim to evaluate the changes of global coagulation assays in patients with CKD undergoing haemodialysis.
Methods
This prospective observational study recruited patients undergoing hemodialysis. Fasting blood samples were collected prior to starting hemodialysis for baseline investigations such as full blood evaluation, coagulation studies and lipid studies, in addition to experimental testing via thromboelastography (TEG® 5000S) utilising citrated whole blood. Additional samples were double-centrifuged to obtain platelet-poor plasma for later assessment with calibrated automated thrombogram (CAT) and overall haemostasis potential (OHP).
Results
Twenty-six patients were recruited and the results were compared to age-matched normal controls previously collected. Hemodialysis patients had lower platelet count with increased fibrinogen, VWF antigen and factor VIII levels (p<0.01). They also had more hypercoagulable TEG® profile when compared to normal controls, with increased maximal amplitude (69.6 vs 60.0 mm, p<0.001) and reduced clot lysis (0.0% vs 0.4%, p=0.001). Interestingly, there was no significant difference in the thrombin generation parameters. In addition, D-dimer was markedly increased in hemodialysis patients independent of age (860 vs 189 ng/mL, p<0.001) but this did not correlate with fibrin generation parameters.
Conclusion
Hemodialysis patients appear to have a more hypercoagulable state characterised by increased fibrinogen, VWF antigen and factor VIII levels, as well as TEG parameters. D-dimer was markedly increased, which brings into question the clinical usefulness of D-dimer in predicting venous thromboembolism in haemodialysis patients. The lack of correlation with fibrinolytic potential may signify reduced renal clearance of D-dimer.