STATUS OF PRO- AND ANTICOAGULANT COMPONENTS OF HEMOSTASIS IN PATIENTS WITH STAGE VD CKD DEPENDING ON RESIDUAL RENAL FUNCTION.

OBJECTIVE: The aim: To study the status of pro- and anticoagulant components of hemostasis in patients with stage VD CKD depending on residual renal function. PATIENTS AND METHODS: Materials and methods: 88 patients with stage VD CKD were studied, 16 of them had preserved residual renal function (RRF). Hemostatic parameters - soluble fibrin, D-dimer and protein C - were determined in the patients. RESULTS: Results: Significant increase in soluble fibrin and fibrinogen levels along with depressive reaction of D-dimer and protein C were found in patients with stage VD CKD having lost RRF. Preserved RRF in those patients had positive influence on hemostatic profile, decreasing the degree of hypercoagulation. CONCLUSION: Conclusions: 1. In long term dialysis patients with stage VD CKD and lost RRF, significantly increased levels in soluble fibrin and fibrinogen along with decreased D-dimer concentration were found, being a key factor in the development of thrombotic complications. 2. There was significant decrease in protein C activity in patients with lost RRF. 3. Preserved RRF in patients with stage VD CKD had positive influence on hemostatic profile.

Predictors Of Thrombogenesis By The State Of Pro- And Anticoagulant Components Of Hemostasis In The Patients With Stage Vd Chronic Kidney Disease.

OBJECTIVE: Introduction: One of the major complications of stage V chronic kidney disease (CKD), treated by program hemodialysis, are hemostatic system disturbances resulting in thrombosis development. To detect early predictors of potential thrombosis in study category of patients is rather difficult because of inflammatory process, accumulation of antibodies, continuous damage of blood elements. The aim: To estimate potential applicability of activators and inhibitors of thrombogenesis as thrombophilia markers in the patients with stage V CKD, treated by program hemodialysis. PATIENTS AND METHODS: Materials and methods:88 patients (52 males and 36 females) with stage V CKD, treated by program hemodialysis, were studied. Hemostatic profile was estimated in all the patients (soluble fibrin, D-dimer, protein C, fibrinogen). RESULTS: Results: Two thirds of the patients with stage V CKD, treated by program hemodialysis, had significant increase in soluble fibrin and fibrinogen concentration against the background of decrease of natural anticoagulant - protein C and disparate response of D-dimer (tendency to decrease). It was established that comprehensive estimation of activators and inhibitors of thrombogenesis can become an indicator of thrombophilias in the patients with stage V CKD, treated by long term hemodialysis. CONCLUSION: Conclusions: The majority of patients (68.2%) with stage VD CKD, treated by long term hemodialysis, had significant increase of soluble fibrin level (р <0.02) along with decreased D-dimer to borderline values. In general group of patients there was significant decrease of protein C (р<0.05) on the background of great increase of fibrinogen concentration in the majority of patients (62%) (р <0.001). The females were found to have significant increase of D-dimer level (р <0.05) along with the increase of soluble fibrin concentration. Comprehensive determination of activators and inhibitors of thrombogenesis can serve an indicator of thrombophilias in the patients with stage VD CKD, treated by program hemodialysis.

[Discriminant analysis for prognosis of thrombophilia development in patients with stage VD CKD].

OBJECTIVE: Introduction: Chronic kidney disease (CKD) is a critical medical and social problem. Every year 7& of such patients require renal replacement therapy associated with one of the most life threatening complications - disturbed hemostasis and development of thrombophilic conditions which are typical of complicated comorbid diseases. Prediction of potential thrombogenesis in that category of patients requires multidimensional approach, including comprehensive laboratory investigation of hemostasis on the one hand, and creation of mathematical model based on thrombophilia predictors on the other. The aim: To create the prognostic model of thrombophilia development in patients with stage VD CKD, treated by long term hemodialysis, using discriminant function analysis and biochemical variables of hemostasis. PATIENTS AND METHODS: Materials and methods: Of 12 hemostatic parameters (factors of influence), studied in 85 patients with stage VD CKD, two groups of variables were formed - pre-thrombosis (soluble fibrin (sF), D-dimer (D-d), protein C (PC)) and post-thrombosis (D-d, H (maximal end turbidity of plasma clot) and pC). RESULTS: Results: Linear discriminant functions (two models), based on two groups of variables, demonstrated rather high coincidence rate (92.2÷93.5&) in group distribution. The patients referred to those with thrombotic complications, 100& matched the prospective (for a year) study. CONCLUSION: Conclusions: By the results of correlation analysis, the most significant molecular biochemical hemostatic parameters (sF, D-d, pC, H) were determined. Using definite biochemical parameters, discriminant models complementing each other and having high prediction (р <0.0001) of thrombophilic states in 92.2-93.5& of cases, were developed for patients with stage VD CKD, treated by long term hemodialysis.