Keywords
renal insufficiency, chronic
acute kidney injury
uremia
renal dialysis
thrombelastography
point-of-care
acute kidney injury
uremia
renal dialysis
thrombelastography
point-of-care
How to Cite
1.
Torres Serrano RE, Benavides Tamayo HE. Thromboelastographic alterations in patients with dialytic urgency. Rev. Colomb. Nefrol. [Internet]. 2021 Feb. 16 [cited 2024 Apr. 18];8(2):e542. Available from: https://revistanefrologia.org/index.php/rcn/article/view/542
Abstract
Background: Kidney disease causes alterations of hemostasis increasing the risk of thrombotic and hemorrhagic events.
Objective: Describe coagulation abnormalities in patients with kidney disease and dialytic urgency according to thrombelastography and conventional tests.
Materials and methods: Case series of 60 patients hospitalized due to dialytic urgency. Blood samples were taken prior to implantation hemodialysis catheter or peritoneal catheter, processed for thrombelastography and conventional tests.
Results: In the global interpretation of the thrombelastography hypercoagulable state was identified in 60% of the patients. In the individual analysis of the parameters of the plot, alterations in the enzymatic phase were demonstrated with an increased alpha-angle in 61.7% and shortened R time in 58.3% of the cases, alterations in the cellular phase with increased MA and G by about 45% and hyperfibrinolysis in 18%. The aPTT was prolonged by 23.7% of cases.
Conclusions: In the overall interpretation of the thrombelastography of patients with dialytic urgency, the most frequent disorder was the hypercoagulable state. In the individual analysis, alterations were found in all the phases of coagulation, the most frequent being the accelerated formation of the clot, followed by an increase in strength. Thrombelastography should be considered as point-of-care test for the assessment of hemostasis in these patients.
Key words: renal insufficiency, chronic; acute kidney injury; uremia; renal dialysis; thrombelastography; point-of-care
References
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https://doi.org/10.1007/978-1-4939-7196-1_39
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https://doi.org/10.1097/00001721-200107000-00001
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https://doi.org/10.1213/ane.0b013e31818f8907
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https://doi.org/10.1016/0049-3848(87)90091-0
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https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.026
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https://doi.org/10.1160/TH10-12-0785
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https://doi.org/10.1007/s11239-015-1247-x
41. Huang MJ, Wei RB, Wang ZC, Xing Y, Gao YW, Li MX, et al. Mechanisms of hypercoagulability in nephrotic syndrome associated with membranous nephropathy as assessed by thromboelastography. Thromb Res. 2015;136(3):663-8.
https://doi.org/10.1016/j.thromres.2015.06.031
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43. Chapman M, Moore EE, et al. Thrombelastographic Pattern Recognition in Renal Disease and Trauma. J Surg Res. 2015;194(1):1-7.
https://doi.org/10.1016/j.jss.2014.12.012
44. Zambruni A, Thalheimer U, Leandro G, Perry D, Burroughs AK. Thromboelastography with citrated blood: comparability with native blood, stability of citrate storage and effect of repeated sampling. Blood Coagul Fibrinolysis. 2004;15(1):103-7.
https://doi.org/10.1097/00001721-200401000-00017
45. Gurbel PA, Bliden KP, Tantry US, Monroe AL, Muresan AA, Brunner NE, et al. First report of the point-of-care TEG: A technical validation study of the TEG-6S system. Platelets. 2016;27(7):642-9.
https://doi.org/10.3109/09537104.2016.1153617
https://doi.org/10.1038/nrdp.2017.88
2. Meyer TW, Hostetter TH. Uremia. N Engl J Med. 2007;357(13):1316-25.
https://doi.org/10.1056/NEJMra071313
3. International Society of Nephrology. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International Supplements. 2012;2(1):1-138.
4. Hoffman M, Monroe DM 3rd. A Cell-based Model of Hemostasis. Thromb Haemost. 2001;85(6):958-65.
https://doi.org/10.1055/s-0037-1615947
5. Furie B, Furie BC. Mechanisms of Thrombus Formation. N Engl J Med. 2008;359(9):938-49.
https://doi.org/10.1056/NEJMra0801082
6. Roberts HR, Monroe DM, Escobar MA. Current Concepts of Hemostasis. Anesthesiology. 2004;100(3):722-30.
https://doi.org/10.1097/00000542-200403000-00036
7. Alvarado Ivan Mauricio. Fisiología de la coagulación nuevos conceptos aplicados al cuidado perioperatorio. Univ.Méd. 2013;54(3):338-52.
https://doi.org/10.11144/Javeriana.umed54-3.fcnc
8. Cesarman-Maus G, Hajjar KA. Molecular mechanisms of fibrinolysis. Br J Haematol. 2005;129(3):307-21.
https://doi.org/10.1111/j.1365-2141.2005.05444.x
9. Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2015;66(1): suppl(1):S1-S305.
https://doi.org/10.1053/j.ajkd.2015.07.013
10. Cuenta de alto costo. Situación de la enfermedad renal crónica, la hipertensión arterial y la diabetes mellitus. Cuenta alto costo. 2017;280. Available from:
https://cuentadealtocosto.org/site/images/Publicaciones/2018/Libro_Situacion_ERC_en_Colombia_2017.pdf
11. Jalal DI, Chonchol M, Targher G. Disorders of hemostasis associated with chronic kidney disease. Semin Thromb Hemost. 2010;36(1):34-40.
https://doi.org/10.1055/s-0030-1248722
12. Pavord S, Myers B. Bleeding and thrombotic complications of kidney disease. Blood Rev. 2011;25(6):271-8
https://doi.org/10.1016/j.blre.2011.07.001
13. Mielke CH Jr, Rapaport SI et al. The standardized normal Ivy bleeding time and its prolongation by aspirin. Blood. 1969;34(2):204-15
https://doi.org/10.1182/blood.V34.2.204.204
14. Toukh M, Siemens DR, Black A, Robb S, Leveridge M, Graham CH, et al. Thromboelastography identifies hypercoagulablilty and predicts thromboembolic complications in patients with prostate cancer. Thromb Res. 2014;133(1):88-95.
https://doi.org/10.1016/j.thromres.2013.10.007
15. Hunt BJ. Bleeding and Coagulopathies in Critical Care. N Engl J Med. 2014;370(9):847-59.
https://doi.org/10.1056/NEJMra1208626
16. Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost. 2004;30(5):579-89.
https://doi.org/10.1055/s-2004-835678
17. Kaw D, Malhotra D. Platelet dysfunction and end-stage renal disease. Semin Dial. 2006;19(4):317-22.
https://doi.org/10.1111/j.1525-139X.2006.00179.x
18. Molino D, De Lucia D, De Santo NG. Coagulation disorders in uremia. Semin Nephrol. 2006;26(1):46-51.
https://doi.org/10.1016/j.semnephrol.2005.06.011
19. Hassan AA, Kroll MH. Acquired Disorders of Platelet Function. Hematology Am Soc Hematol Educ Program 2005:403-8.
https://doi.org/10.1182/asheducation-2005.1.403
20. Sohal AS, Gangji AS, Crowther MA, Treleaven D. Uremic bleeding: Pathophysiology and clinical risk factors. Thromb Res. 2006;118(3):417-22.
https://doi.org/10.1016/j.thromres.2005.03.032
21. Galbusera M, Remuzzi G, Boccardo P. Treatment of bleeding in dialysis patients. Semin Dial. 2009;22(3):279-86.
https://doi.org/10.1111/j.1525-139X.2008.00556.x
22. Lutz J, Menke J, Sollinger D, Schinzel H, Thürmel K. Haemostasis in chronic kidney disease. Nephrol Dial Transplant. 2014;29(1):29-40.
https://doi.org/10.1093/ndt/gft209
23. Rochon AG, Shore-Lesserson L. Coagulation Monitoring. Anesthesiology Clinics of North America. 2006;24(4):839-856
https://doi.org/10.1016/j.atc.2006.08.003
24. Soyoral YU, Demir C, Begenik H, Esen R, Kucukoglu ME, Aldemir MN, et al. Skin bleeding time for the evaluation of uremic platelet dysfunction and effect of dialysis. Clin Appl Thromb. 2012;18(2):185-8.
https://doi.org/10.1177/1076029611427438
25. Maleki A, Rashidi N, Almasi V, Montazeri M, Forughi S, Alyari F. Normal range of bleeding time in urban and rural areas of Borujerd, west of Iran. ARYA Atheroscler. 2014;10(4):199-202.
26. Lipets EN, Ataullakhanov FI. Global assays of hemostasis in the diagnostics of hypercoagulation and evaluation of thrombosis risk. Thromb J. 2015;13(1):4.
https://doi.org/10.1186/s12959-015-0038-0
27. Nguyen A, Dasgupta A, Wahed A. Coagulation-Based Tests and Their Interpretation. Manag Hemost Coagulopathies Surg Crit Ill Patients. 2016;1-16.
https://doi.org/10.1016/B978-0-12-803531-3.00001-X
28. Othman M, Kaur H. Thromboelastography (TEG). Methods Mol Biol. 2017; 1646:533-543
https://doi.org/10.1007/978-1-4939-7196-1_39
29. Raffán F, Ramírez FJ, Cuervo JA, y cols. Tromboelastografía. Rev Colomb Anestesiol. 2005;33(3):181
30. Luddington RJ. Thrombelastography / thromboelastometry. 2005;81-90.
https://doi.org/10.1111/j.1365-2257.2005.00681.x
31. Salooja N, Perry DJ. Thrombelastography. 2001;12(5):327-37.
https://doi.org/10.1097/00001721-200107000-00001
32. Levi M, Hunt BJ. A critical appraisal of point-of-care coagulation testing in critically ill patients. J Thromb Haemost 2015;13(11):1960-1967.
https://doi.org/10.1111/jth.13126
33. Wikkelsø A, Wetterslev J, et al. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2016;(8):CD007871.
https://doi.org/10.1002/14651858.CD007871.pub3
34. Dai Y, Lee A, Critchley LAH, White PF. Does thromboelastography predict postoperative thromboembolic events? a systematic review of the literature. Anesth Analg. 2009;108(3):734-42.
https://doi.org/10.1213/ane.0b013e31818f8907
35. Chitlur M, Sorensen B, Rivard GE, Young G, Ingerslev J, Othman M, et al. Standardization of thromboelastography: A report from the TEG-ROTEM working group. Haemophilia. 2011;17(3):532-7.
https://doi.org/10.1111/j.1365-2516.2010.02451.x
36. Holloway DS, Vagher JP, Caprini JA, et al. Thrombelastography of blood from subjects with chronic renal failure. Thromb Res 1987;45:817-25.
https://doi.org/10.1016/0049-3848(87)90091-0
37. Nunns GR, Moore EE, Chapman MP, Moore HB, Stettler GR, Peltz E, et al. The hypercoagulability paradox of chronic kidney disease: The role of fibrinogen. Am J Surg. 2017;214(6):1215-8.
https://doi.org/10.1016/j.amjsurg.2017.08.039
38. Meier K, Saenz DM, Torres GL, Cai C, Rahbar MH, McDonald M, et al. Thrombelastography Suggests Hypercoagulability in Patients with Renal Dysfunction and Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis. 2018;27(5):1350-6.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.026
39. Darlington A, Ferreiro JL, Ueno M, Suzuki Y, Desai B, Capranzano P, et al. Haemostatic profiles assessed by thromboelastography in patients with end-stage renal disease. Thromb Haemost. 2011;106(1):67-74.
https://doi.org/10.1160/TH10-12-0785
40. Huang M jie, Wei R bao, Li Q ping, Yang X, Cao C ming, Su T yu, et al. Hypercoagulable state evaluated by thromboelastography in patients with idiopathic membranous nephropathy. J Thromb Thrombolysis. 2016;41(2):321-7.
https://doi.org/10.1007/s11239-015-1247-x
41. Huang MJ, Wei RB, Wang ZC, Xing Y, Gao YW, Li MX, et al. Mechanisms of hypercoagulability in nephrotic syndrome associated with membranous nephropathy as assessed by thromboelastography. Thromb Res. 2015;136(3):663-8.
https://doi.org/10.1016/j.thromres.2015.06.031
42. Huang MJ, Wei RB, Wang Y, Su TY, Di P, Li QP, et al. Blood coagulation system in patients with chronic kidney disease: A prospective observational study. BMJ Open. 2017;7(5):7-13.
https://doi.org/10.1136/bmjopen-2016-014294
43. Chapman M, Moore EE, et al. Thrombelastographic Pattern Recognition in Renal Disease and Trauma. J Surg Res. 2015;194(1):1-7.
https://doi.org/10.1016/j.jss.2014.12.012
44. Zambruni A, Thalheimer U, Leandro G, Perry D, Burroughs AK. Thromboelastography with citrated blood: comparability with native blood, stability of citrate storage and effect of repeated sampling. Blood Coagul Fibrinolysis. 2004;15(1):103-7.
https://doi.org/10.1097/00001721-200401000-00017
45. Gurbel PA, Bliden KP, Tantry US, Monroe AL, Muresan AA, Brunner NE, et al. First report of the point-of-care TEG: A technical validation study of the TEG-6S system. Platelets. 2016;27(7):642-9.
https://doi.org/10.3109/09537104.2016.1153617
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