Abstract: PO0542
Evaluation of Thromboelastometry and Multiple Electrode Aggregometry in ESRD
Session Information
- CKD Clinical, Outcomes, and Trials - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Abdelmaguid, Alyaa, King’s Kidney Care, King’s College Hospital, London, United Kingdom
- Roberts, Lara N., King’s Thrombosis Centre, Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Joslin, Jennifer R., King’s Kidney Care, King’s College Hospital, London, United Kingdom
- Hunt, Beverley, Thrombosis and Haemostasis Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Parmar, Kiran H., Thrombosis and Haemostasis Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Bramham, Kate, King’s Kidney Care, King’s College Hospital, London, United Kingdom
Background
Bleeding and thrombosis rates are paradoxically increased in chronic kidney disease (CKD), but risk assessment for both is not possible with routine laboratory tests. We aimed to evaluate haemostatic changes in CKD stage 5 patients with modern techniques; using thromboelastometry (TEM), multiple electrode aggregometry (MEA), markers of thrombogenesis, fibrinolysis and endothelial activation.
Methods
TEM, MEA, thrombin antithrombin (TAT), alpha-2 antiplasmin, d-dimer and Intercellular Adhesion Molecule-1 (ICAM-1) were quantified in 50 CKD Stage 5 patients (including 20 haemodialysis patients) and 30 healthy controls. Patients taking antiplatelet agents were excluded from MEA analysis.
Results
TEM parameters showed hypercoagulability, with increased maximal clot firmness (MCF) & shorter clot formation time (CFT); and D-dimer, TAT and ICAM-concentrations were also increased in CKD Stage 5 patients compared to HC (Table 1).
Platelet dysfunction was evident in CKD Stage 5 with lower aggregation in ADPtest and TRAPtest compared to HC.
Conclusion
Our study shows that the prothrombotic changes in CKD Stage 5 are due to increased coagulation and endothelial activation. Bleeding tendency may relate to platelet dysfunction and possibly increased fibrinolytic activation.
Table (1): Comparison of TEM, MEA, Alpha-2 Antiplasmin, D-dimer, Thrombin Antithrombin and ICAM-1 between Healthy Controls and CKD Stage 5 (Median and Interquartile Range (IQR))
Healthy Controls n=30 | CKD Stage 5 n=50 | p-value | |
TEM | |||
EXTEM CT (42-74 sec) | 56 (52,60) | 58 (55,62) | p=0.056 |
EXTEM CFT (46-148 sec) | 68 (62,81) | 49 (40,66) | p<0.001 |
EXTEM MCF (49-71 mm) | 67 (65,70) | 72 (67,74) | p<0.001 |
FIBTEM MCF (9-25mm) | 18 (15, 21) | 25 (20, 32) | p=0.004 |
MEA | |||
ADPtest (57-113 U) | 61 (41,78) | 37 (20,61) | p=0.005 |
ASPItest (71-115 U) | 75 (56,89) | 64 (48,100) | p=0.904 |
TRAPtest (84-128 U) | 112 (84,121) | 78 (53,116) | p=0.012 |
Alpha-2 Antiplasmin ug/L | 2173 (994,3641) | 3075 (622,8000) | p=0.266 |
D-dimer µg/mL FEU | 0.22 (0.14, 0.30) | 0.76 (0.39, 1.52) | p<0.001 |
Thrombin Antithrombin ug/L | 1.65 (1.01,2.49) | 2.26 (1.58,3.82) | p=0.019 |
ICAM-1 ug/L | 222 (191,248) | 288 (249,326) | p<0.001 |
TEM: Thromboelastometry, CT: Clot Time, CFT: Clot Firmness Time, MCF: Maximum Clot Firmness, MEA: Multiple Electrode Aggregometry, ICAM-1: Intercellular Adhesion Molecule-1