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Kidney Week

Abstract: TH-PO349

Coagulation Differences in Dialysis Vascular Access Failure

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Wentworth, Danielle, University of Virginia Division of Nephrology, Charlottesville, Virginia, United States
  • Portz, Brent J., University of Virginia Division of Nephrology, Charlottesville, Virginia, United States
  • Erdbruegger, Uta, University of Virginia Division of Nephrology, Charlottesville, Virginia, United States
Background

Vascular access failure in hemodialysis patients is often caused by access stenosis or thrombosis. Neointimal proliferation and abnormal coagulation play important pathogenetic roles. Currently, no biomarker is available for prediction of access failure leading to stenosis and thrombosis. Sonorehometry is a novel tool assessing blood clot elasticity. We hypothesize blood clot elasticity can be a valuable tool to diagnose vascular access complications in hemodialysis.

Methods

In a cross-sectional study, conventional markers of coagulation including Fibrinogen, platelet count, PT/INR, and aPTT were measured in 21 patients on chronic hemodialysis (for over 3 months). 6 patients had recurrent vascular access failure caused by concurrent thrombosis and stenosis, 9 patients had recurrent access stenosis without thrombosis and 6 patients had functioning access without complications. For each patient, QPlus Cartridge was run on Quantra analyzer to measure coagulation parameters, including Clot Stiffness (CS). Kruskal – Wallis Test was used for in group comparisons and Pearson / Spearman analysis for correlation of fibrinogen level, platelets count and CS.

Results

There was no statistical differences in stiffness parameters in the 3 subpopulations. However, the patients with recurrent vascular access complications caused by Thrombosis/Stenosis had high CS values (figure 1). Numerically higher fibrinogen values were found in patients with vascular access complications.

Conclusion

Hemodialysis patients with recurrent vascular access complications due to thrombosis/stenosis might have higher clot stiffness and signs for a hypercoagulable state explained by the renal failure. A larger cohort needs to be examined to confirm findings and demonstrate that clot stiffness can be utilized to monitor dialysis patients for vascular access complications.