Variability in Coagulation Profiles in Patients with Chronic Kidney Disease and Peripheral Artery Disease.

BACKGROUND

Chronic Kidney Disease (CKD) has been associated with a prothrombotic state. CKD affects hemostasis through altered platelet function and coagulation factors. Traditional tests provide limited insight into these changes. We used Thromboelastography (TEG) to evaluate coagulation profiles in CKD and non-CKD patients, comparing parameters based on glomerular filtration rate (GFR) to better understand clotting dynamics. The aim of the study was to evaluate coagulation profiles in patients across GFR categories using Thromboelastography (TEG), which enables comprehensive assessment of clot formation dynamics.

METHODS

We prospectively evaluated patients with peripheral artery disease undergoing revascularization (December 2020-2023). Patients were stratified by GFR into 3 groups: >60 mL/min, 30-59 mL/min, and <30 mL/min. Pre-surgical blood samples were analyzed using TEG parameters, including Maximum Amplitude (MA), Citrated Functional Fibrinogen (CFF), and Functional Fibrinogen Levels (FLEV). Statistical analysis employed Kruskal-Wallis tests.

RESULTS

Among 254 patients (182 with GFR >60, 56 with GFR 30-59, and 16 with GFR <30), those with declining kidney function showed progressively higher values in CRT MA (62.80 vs. 65.85 vs. 67.85 mm, P = 0.0021), CK MA (61.10 vs. 64.00 vs. 66.70 mm, P = 0.0063), CFF MA (21.40 vs. 24.10 vs. 33.70 mm, P = 0.0017), and CFF FLEV (390.5 vs. 487.2 vs. 556.6 mg/dL, P = 0.0029). This pattern persisted in patients on mono antiplatelet therapy (MAPT). Patients receiving MAPT showed consistently higher coagulation marker levels compared to those on dual antiplatelet therapy (DAPT), particularly in severe renal impairment (GFR <30).

CONCLUSION

Patients with decreased kidney function demonstrated relative hypercoagulability compared to those with normal kidney function, as evidenced by elevated fibrinogen levels and stronger blood clots. While DAPT was associated with lower coagulation marker levels compared to MAPT, platelet reactivity remained similar across GFR categories. However, these laboratory findings did not translate into increased clinical events, with no significant differences in bleeding episodes (P = 0.436) or arterial thrombotic events (P = 0.095) across GFR categories.