Blood coagulation system in patients with chronic kidney disease: a prospective observational study
Objectives Thromboembolic events are the major factor affecting the prognosis of patients with chronic kidney disease (CKD). Haemostatic alterations are possible causes of these complications, but their roles remain poorly characterised. In the prospective observational study, we investigated the en...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2017-06-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/5/e014294.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823857273826443264 |
|---|---|
| author | Xi Yang Yang Wang Ri-bao Wei Ting-yu Su Meng-jie Huang Ping Li Xiang-mei Chen Ping Di Qing-ping Li |
| author_facet | Xi Yang Yang Wang Ri-bao Wei Ting-yu Su Meng-jie Huang Ping Li Xiang-mei Chen Ping Di Qing-ping Li |
| author_sort | Xi Yang |
| collection | DOAJ |
| description | Objectives Thromboembolic events are the major factor affecting the prognosis of patients with chronic kidney disease (CKD). Haemostatic alterations are possible causes of these complications, but their roles remain poorly characterised. In the prospective observational study, we investigated the entire coagulation process in patients with CKD to elucidate the mechanisms of their high thromboembolic risk.Methods A total of 95 patients with CKD and 20 healthy controls who met the inclusion criteria were consecutively recruited from September 2015 to March 2016. The platelet count, platelet aggregation, von Willebrand factor antigen (vWF:Ag), vWF ristocetin cofactor activity (vWF:RCo), fibrinogen, factor V (FV), FVII, FVIII, antithrombin III, protein C, protein S, D-dimer, standard coagulation tests and thromboelastography were measured in patients with CKD and controls. Associations between the estimated glomerular filtration rate (eGFR) and haemostatic biomarkers were tested using multivariable linear regression.Results The adjusted and unadjusted levels of vWF:Ag, vWF:RCo, fibrinogen, FVII, FVIII and D-dimer were significantly higher in patients with CKD than that in the healthy controls, and were elevated with CKD progression. However, after adjustment for baseline differences, platelet aggregation and thromboelastography parameters showed no significant differences between patients with CKD and healthy controls. In the correlation analysis, vWF:Ag, vWF:RCo and FVIII were inversely associated with eGFR (r=−0.359, p<0.001; r=−0.391, p<0.001; r=−0.327, p<0.001, respectively). During the 1-year of follow-up, one cardiovascular event occurred in patients with CKD 5 stage, whereas no thromboembolic event occurred in the CKD 3 and 4 and control groups.Conclusions Patients with CKD are characterised by endothelial dysfunction and increased coagulation, especially FVIII activity. The abnormal haemostatic profiles may contribute to the elevated risk of thrombotic events but further longer-term study with large samples is still required to more precisely determine the relationship between the elevation of procoagulant factors and clinical outcomes. |
| format | Article |
| id | doaj-art-499ea390349141bcbfef4886da24f93d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-499ea390349141bcbfef4886da24f93d2025-02-11T22:40:14ZengBMJ Publishing GroupBMJ Open2044-60552017-06-017510.1136/bmjopen-2016-014294Blood coagulation system in patients with chronic kidney disease: a prospective observational studyXi Yang0Yang Wang1Ri-bao Wei2Ting-yu Su3Meng-jie Huang4Ping Li5Xiang-mei Chen6Ping Di7Qing-ping Li8School of Health Management, Harbin Medical University, Harbin, China1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China1 Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China1 Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China1 Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, ChinaDepartment of Reproductive Medicine, Women and Children`s Hospital, School of Medicine, Xiamen university, Xiamen, Fujian, China1 Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China2 Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing, China1 Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, ChinaObjectives Thromboembolic events are the major factor affecting the prognosis of patients with chronic kidney disease (CKD). Haemostatic alterations are possible causes of these complications, but their roles remain poorly characterised. In the prospective observational study, we investigated the entire coagulation process in patients with CKD to elucidate the mechanisms of their high thromboembolic risk.Methods A total of 95 patients with CKD and 20 healthy controls who met the inclusion criteria were consecutively recruited from September 2015 to March 2016. The platelet count, platelet aggregation, von Willebrand factor antigen (vWF:Ag), vWF ristocetin cofactor activity (vWF:RCo), fibrinogen, factor V (FV), FVII, FVIII, antithrombin III, protein C, protein S, D-dimer, standard coagulation tests and thromboelastography were measured in patients with CKD and controls. Associations between the estimated glomerular filtration rate (eGFR) and haemostatic biomarkers were tested using multivariable linear regression.Results The adjusted and unadjusted levels of vWF:Ag, vWF:RCo, fibrinogen, FVII, FVIII and D-dimer were significantly higher in patients with CKD than that in the healthy controls, and were elevated with CKD progression. However, after adjustment for baseline differences, platelet aggregation and thromboelastography parameters showed no significant differences between patients with CKD and healthy controls. In the correlation analysis, vWF:Ag, vWF:RCo and FVIII were inversely associated with eGFR (r=−0.359, p<0.001; r=−0.391, p<0.001; r=−0.327, p<0.001, respectively). During the 1-year of follow-up, one cardiovascular event occurred in patients with CKD 5 stage, whereas no thromboembolic event occurred in the CKD 3 and 4 and control groups.Conclusions Patients with CKD are characterised by endothelial dysfunction and increased coagulation, especially FVIII activity. The abnormal haemostatic profiles may contribute to the elevated risk of thrombotic events but further longer-term study with large samples is still required to more precisely determine the relationship between the elevation of procoagulant factors and clinical outcomes.https://bmjopen.bmj.com/content/7/5/e014294.full |
| spellingShingle | Xi Yang Yang Wang Ri-bao Wei Ting-yu Su Meng-jie Huang Ping Li Xiang-mei Chen Ping Di Qing-ping Li Blood coagulation system in patients with chronic kidney disease: a prospective observational study BMJ Open |
| title | Blood coagulation system in patients with chronic kidney disease: a prospective observational study |
| title_full | Blood coagulation system in patients with chronic kidney disease: a prospective observational study |
| title_fullStr | Blood coagulation system in patients with chronic kidney disease: a prospective observational study |
| title_full_unstemmed | Blood coagulation system in patients with chronic kidney disease: a prospective observational study |
| title_short | Blood coagulation system in patients with chronic kidney disease: a prospective observational study |
| title_sort | blood coagulation system in patients with chronic kidney disease a prospective observational study |
| url | https://bmjopen.bmj.com/content/7/5/e014294.full |
| work_keys_str_mv | AT xiyang bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT yangwang bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT ribaowei bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT tingyusu bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT mengjiehuang bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT pingli bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT xiangmeichen bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT pingdi bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy AT qingpingli bloodcoagulationsysteminpatientswithchronickidneydiseaseaprospectiveobservationalstudy |