POS-561 PERSISTENT COAGULATION ABNORMALITIES IN END-STAGE RENAL DISEASE AFTER 1-YEAR OF FOLLOW UP

Abstract

Common to end-stage renal disease (ESRD), coagulation abnormalities can lead to severe bleeding events or excessive thrombi formation and engender increased morbidity and mortality in this population. Repeated heparin administration to ESRD patients during maintenance hemodialysis may also contribute to changes in the coagulation system. Thus, profiling coagulation parameters in ESRD patients over 1-year may provide insight to long-term coagulation dysfunction in this population. Blood samples were collected at baseline and 1-year from ESRD patients undergoing maintenance hemodialysis (n=95) 48-hours post-dialysis. Plasma samples were analyzed using clot-based methods including activated partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin time (TT). Chromogenic assays measured heparin levels by anti-Xa and anti-IIa methods. Patients were categorized by heparin administration during dialysis (n=44) and compared via statistical method and percent change. In the clotting and chromogenic assays, all parameters were elevated in the baseline and 1-year ESRD cohorts compared to controls, as shown on Figure 1. Only anti-IIa levels demonstrated a significant difference in ESRD patients after 1-year (p<0.0001). Heparin administration varied in aPTT, TT, and anti-Xa (p<0.05). These results suggest ESRD patients on dialysis exhibit a long-term, hypo-coagulable state as shown by prolonged aPTT and TT. Elevated parameters maintained over 1-year suggests persistent dysregulation of clotting factors in ESRD patients. Circulating levels of heparin, as evidenced by anti-Xa and anti-IIa assays may be due to impaired clearance of heparin components via dialysis.