Geoffrey R Nunns1, Ernest E Moore2, Michael P Chapman3, Hunter B Moore1, Gregory R Stettler1, Erik Peltz1, Clay C Burlew4, Christopher C Silliman5, Anirban Banerjee1, Angela Sauaia6. 1. Department of Surgery, University of Colorado Denver, Aurora, CO, USA. 2. Department of Surgery, University of Colorado Denver, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA. Electronic address: ernest.moore@dhha.org. 3. Department of Radiology, University of Colorado Denver, Aurora, CO, USA. 4. Department of Surgery, Denver Health Medical Center, Denver, CO, USA. 5. Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA; Research Laboratory, Bonfils Blood Center, Denver, CO, USA. 6. Department of Surgery, University of Colorado Denver, Aurora, CO, USA; School of Public Health, University of Colorado Denver, Aurora, CO, USA.
Abstract
BACKGROUND: Chronic kidney disease (CKD) patients have increased rates of bleeding as well as thrombosis. Fibrinogen and platelets combine to generate a mature clot, but in CKD platelets are dysfunctional. Therefore, we hypothesize that CKD patients have increased clot strength due to elevated fibrinogen levels. METHODS: Retrospective review of CKD patients (n = 84) who had rTEG and fibrinogen levels measured. They were compared to healthy controls (n = 134). RESULTS: CKD patients had statistically significant increases in ACT, angle, MA and decreases in LY30 compared to controls. Fibrinogen levels were increased in CKD patients compared to reference range. Fibrinogen levels had a positive correlation with MA (rho = 0.709, p < 0.0001) in CKD patients. CONCLUSIONS: Patients with CKD manifest a coagulopathy consisting of delayed clot formation, but increased final clot strength and decreased clot breakdown. Furthermore, the elevated clot strength is mediated by increased fibrinogen levels in CKD patients.
BACKGROUND:Chronic kidney disease (CKD) patients have increased rates of bleeding as well as thrombosis. Fibrinogen and platelets combine to generate a mature clot, but in CKD platelets are dysfunctional. Therefore, we hypothesize that CKDpatients have increased clot strength due to elevated fibrinogen levels. METHODS: Retrospective review of CKDpatients (n = 84) who had rTEG and fibrinogen levels measured. They were compared to healthy controls (n = 134). RESULTS:CKDpatients had statistically significant increases in ACT, angle, MA and decreases in LY30 compared to controls. Fibrinogen levels were increased in CKDpatients compared to reference range. Fibrinogen levels had a positive correlation with MA (rho = 0.709, p < 0.0001) in CKDpatients. CONCLUSIONS:Patients with CKD manifest a coagulopathy consisting of delayed clot formation, but increased final clot strength and decreased clot breakdown. Furthermore, the elevated clot strength is mediated by increased fibrinogen levels in CKDpatients.
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