ФАКТОРЫ ТРОМБОЭМБОЛИЧЕСКОГО РИСКА У ПАЦИЕНТОВ ТЕРМИНАЛЬНОЙ СТАДИЕЙ ХБП С ДИАЛИЗНОЙ ТЕРАПИЕЙ И НЕКЛАПАННОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ ПО CHA2 DS2 -VASc И УРОВНЮ D-ДИМЕРА

Abstract

Introduction. Patients suffering from end-stage chronic kidney disease have a high risk of developing rhythm disorders, such as atrial fibrillation, and variations in the hemostatic system. There are only limited options to use the drug-based prophylaxis of thromboembolic complications in patients of this category. Aim. Our study aimed to compare the risk factors of developing thromboembolic complications in end-stage chronic kidney disease (CKD) patients with non-valvular atrial fibrillation, receiving renal replacement therapy, by their CHA2 DS 2-VASc and D-dimer levels. Materials and Methods. A prospective study was conducted on 143 end-stage CKD patients receiving extracorporeal renal replacement therapy in a single dialysis center. In patients with a high risk of thromboembolic complications, the most common signs were found according to the CHA2 DS 2-VASc scale. After examining hemostasis parameters, patients were divided into groups with normal and high D-dimer levels. Logistic and correlation analyses were performed according to the significantly different characteristics studied. Results and Discussion. Non-valvular atrial fibrillation was detected in 36 patients (25.17%), of which a high risk of thromboembolic complications was identified in 15 patients (41.7%). Risk of thromboembolic complications in combination with the high D-dimer level was observed in 7 patients (19.4%). Conclusions. Signs of high thromboembolic risk at the CHA2 DS 2-VASc scale were as follows: Arterial hypertension, vascular diseases, age, and female gender. A high level of D-dimer was closely associated with “dialysis experience,” C-reactive protein and ferritin levels, the primary nosology nature, and the fact of vascular access thrombosis. Assessment level using the CHA2 DS 2-VASc scale did not significantly correlate with an increased level of D-dimer.