Abstract
Coagulation abnormalities in renal pathology are associated with a high thrombotic and hemorrhagic risk. This study aims to investigate the hemostatic abnormalities that are related to the interaction between soluble coagulation factors and blood cells, and the effects of hemodialysis (HD) on it, in end stage renal disease (ESRD) patients. Thirty-two ESRD patients under HD treatment and fifteen healthy controls were included in the study. Whole blood samples from the healthy and ESRD subjects were collected before and after the HD session. Evaluation of coagulation included primary and secondary hemostasis screening tests, proteins of coagulation, fibrinolytic and inhibitory system, and ADAMTS-13 activity. Phosphatidylserine (PS) exposure and intracellular reactive oxygen species (iROS) levels were also examined in red blood cells and platelets, in addition to the platelet activation marker CD62P. Platelet function analysis showed pathological values in ESRD patients despite the increased levels of activation markers (PS, CD62P, iROS). Activities of most coagulation, fibrinolytic, and inhibitory system proteins were within the normal range, but HD triggered an increase in half of them. Additionally, the increased baseline levels of ADAMTS-13 inhibitor were further augmented by the dialysis session. Finally, pathological levels of PS and iROS were measured in red blood cells in close correlation with variations in several coagulation factors and platelet characteristics. This study provides evidence for a complex coagulation phenotype in ESRD. Signs of increased bleeding risk coexisted with prothrombotic features of soluble factors and blood cells in a general hyperfibrinolytic state. Hemodialysis seems to augment the prothrombotic potential, while the persisted platelet dysfunction might counteract the increased predisposition to thrombotic events post-dialysis. The interaction of red blood cells with platelets, the thrombus, the endothelium, the soluble components of the coagulation pathways, and the contribution of extracellular vesicles on hemostasis as well as the identification of the unknown origin ADAMTS-13 inhibitor deserve further investigation in uremia.
Highlights
Along with anemia, coagulation disorders constitute major hematological abnormalities observed in renal pathology [1]
All end stage renal disease (ESRD) patients and control subjects were negative for anti-b2-glycoprotein I (b2-GPI)
This study provides evidence for a complex coagulation phenotype in ESRD that is configurated by soluble and corpuscular factors, their interactions, and the effect of dialysis therapy on both
Summary
Coagulation disorders constitute major hematological abnormalities observed in renal pathology [1]. Uremic toxin accumulation in patients with end stage renal disease (ESRD) promotes platelet abnormalities which are considered to be responsible for the bleeding risk that most of these patients must face [2]. There are many additional risk factors potentially leading to thrombotic events in this group of patients, including blood abnormalities, inflammation, comorbidities, and endothelial dysfunction [3]. The existing studies in hemostatic abnormalities in ESRD are complicated by reporting increased risk for bleeding along with ongoing thrombotic events. The present study is the first one that investigates the crosstalk between soluble coagulation factors and blood cells, its association with the hemostatic abnormalities, and the effects of hemodialysis therapy on it in ESRD patients
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