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Kidney Week

Abstract: PO1037

Variations in the Thrombin Generation Profile and Clotting Factor Levels in the Patients Undergoing Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Siddiqui, Fakiha, Loyola University Medical Center, Maywood, Illinois, United States
  • Bontekoe, Emily, Loyola University Medical Center, Maywood, Illinois, United States
  • Hoppensteadt, Debra, Loyola University Medical Center, Maywood, Illinois, United States
  • Jeske, Walter, Loyola University Medical Center, Maywood, Illinois, United States
  • Bansal, Vinod K., Loyola University Medical Center, Maywood, Illinois, United States
  • Fareed, Jawed, Loyola University Medical Center, Maywood, Illinois, United States
Background

Chronic kidney disease (CKD) patients are at high risk of cardiovascular disorders and thrombosis. CKD-V patients undergoing maintenance hemodialysis exhibit varying degrees of hemostatic dysregulation. Endogenous thrombin potential (ETP) is important to the pathogenesis of vaso-occlusive complications. This study investigated ETP and its relevance to circulating coagulation factor levels in CKD-V patients.

Methods

Citrated blood samples from 95 patients with CKD-V were collected prior to maintenance hemodialysis. Normal human plasma (NHP) was used for referencing purposes. Plasma levels of coagulation factor VII, IX, X and XIII were measured by ELISA. ETP was measured using a kinetic fluorogenic method. Such parameters as peak thrombin, lag time (LT) and area under the curve (AUC) were compiled. Correlation analysis between peak thrombin and coagulation factors was carried out by using GraphPad Prism software.

Results

CKD-V patients did not show any significant difference in factor VII levels (110.6 % vs 112.5 %) and factor X (81.5 % vs 88.2 %). Factor IX levels were elevated (124.3 %) in the CKD-V group in comparison to NHP (100.5 %) similarly factor XIII levels were significantly higher in CKD-V (104.8 %) in comparison to NHP (82.3 %). In the ETP studies, CKD-V patients showed a wide variation in ETP parameters. Peak thrombin levels (107.1 nM vs 168.3 nM) and AUC (589.8 nM*min vs 815.7 nM*min) were lower while lag time was higher (2.89 min vs 2.17 min) in the CKD-V group in comparison to NHP. Coagulation factor VII, IX and X correlated with peak thrombin levels (r = >0.3) whereas factor XIII did not show any significant correlation.

Conclusion

These studies demonstrate that CKD-V patients exhibit a decreased generation of endogenous thrombin with simultaneous consumption of coagulation factors suggesting an ongoing activation of coagulation system. Almost 10% of the CKD-V patients exhibit increased levels of peak thrombin values which correlated with relatively higher levels of clotting factors suggesting a decreased activation of ETP. These studies suggest that a majority of CKD-V patients are in a sustained state of ongoing thrombin generation which may contribute to the observed thrombotic complications in these patients.