Comparative characteristics of hemostasis system in patients with end-stage renal disease admitted for urgent and elective hemodialysis


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Abstract

Aim. To evaluate parameters of hemostasis system in patients with end-stage renal disease (ESRD) with consideration of elective or urgent start of dialysis treatment.
Material and methods. A total of 47 patients with ESRD entered the study. They were divided into two groups depending on urgent (group 1) or elective (group 2) start of hemodialysis. Group 1 consisted of 31 patients (13 female, 18 male) aged 18-86 years, group 2 - of 16 patients (9 female, 7 male) aged 36-79 years. The patients were comparable by ESRD causes. Clinical and laboratory findings were compared: activated partial thromboplastin time, prothrombin time, levels of fibrinogen, soluble complexes fibrin-monomers (SCFM).
Results. Azotemia, hyperkalemia and anemia were close to similar. Group 1 patients had more severe alterations of nutrition status and fat metabolism, marked hyperhydration and hypervolemia, arterial hypertension, more frequent neurological and infectious complications, symptoms of enteritis. Thrombotic complications developed in 51.5%, thromboses of the vascular access in 45% in group 1 vs group 2 which demonstrated only one type of thrombotic complications - thromboses of primary arteriovenous fistula (in 1 patient, 6.25%). Hemorrhagic complications were absent in group 2, in group 1 these developed 5 times less frequently than thromboses. Platelet count was significantly less (p = 0.001) in group 1 than in group 2. Hyperfibrinogenemia occurred in about 65% patients of group 1 and in 46% in group 2. SCFM levels were elevated in both groups, but in group 1 these levels were by 50% higher than in group 2 (p = 0.005). This evidences for stronger activation of intravascular coagulation in patients on urgent hemodialysis.
Conclusion. ESRD patients admitted for urgent hemodialysis had more severe uremic syndrome with stronger activation of blood coagulation than patients admitted for elective hemodialysis. Frequency of thrombosis in patients admitted for urgent hemodialysis was 8.3 times higher than in patients admitted for elective hemodialysis.

About the authors

Galina Vladimirovna Kotlyarova

Первый МГМУ им. И. М. Сеченова

Email: galopa@yandex.ru
аспирант, каф. нефрологии и гемодиализа ФППОВ, Первый МГМУ им. И. М. Сеченова, тел.: 8-499-248-61-55; Первый МГМУ им. И. М. Сеченова

Natal'ya L'vovna Kozlovskaya

Первый МГМУ им. И. М. Сеченова

Email: nkozlovskaya@yandex.ru
д-р мед. наук, проф., каф. нефрологии и гемодиализа ФППОВ, Первый МГМУ им. И. М. Сеченова, тел.: 8-499-248-53-11; Первый МГМУ им. И. М. Сеченова

Sergey Vital'evich Lashutin

Государственная клиническая больница им. С. П. Боткина

Email: hd13@yandex.ru
канд. мед. наук, врач-нефролог, ГКБ им. С. П. Боткина, тел.: 8-495-0945-00-45; Государственная клиническая больница им. С. П. Боткина

Yuriy Viktorovich Komyagin

Государственная клиническая больница им. С. П. Боткина

врач-нефролог, ГКБ им. С. П. Боткина, тел.: 8-495-945-00-45; Государственная клиническая больница им. С. П. Боткина

Elena Alekseevna Shakhnova

Первый МГМУ им. И. М. Сеченова

канд. мед. наук, врач-нефролог, клиника нефрологии, внутренних и профессиональных болезней им. Е. М. Тареева УКБ № 3, Первый МГМУ им. И. М. Сеченова, тел.: 8-499-248-61-55; Первый МГМУ им. И. М. Сеченова

Igor' Aleksandrovich Dobrosmyslov

Первый МГМУ им. И. М. Сеченова

зав. отд-нием "искусственная почка", клиника нефрологии, внутренних и профессиональных болезней им. Е. М. Тареева УКБ № 3, Первый МГМУ им. И. М. Сеченова, тел.: 8-499-248-61-55; Первый МГМУ им. И. М. Сеченова

Evgeniy Mikhaylovich Shilov

Первый МГМУ им. И. М. Сеченова

д-р мед. наук, проф., зав. каф. нефрологии и гемодиализа ФППОВ, Первый МГМУ им. И. М. Сеченова, тел.: 8-499-248-59-55; Первый МГМУ им. И. М. Сеченова

Svetlana Georgievna Nesterova

Первый МГМУ им. И. М. Сеченова

Межклиническая коагулологическая лаб., Первый МГМУ им. И. М. Сеченова, тел.: 8-499-248-59-52; Первый МГМУ им. И. М. Сеченова

G V Kotlyarova

I.M. Sechenov First Moscow State Medical University, Moscow

I.M. Sechenov First Moscow State Medical University, Moscow

N L Kozlovskaya

I.M. Sechenov First Moscow State Medical University, Moscow

I.M. Sechenov First Moscow State Medical University, Moscow

S V Lashutin

S.P. Botkin State Hospital, Moscow

S.P. Botkin State Hospital, Moscow

Yu V Komyagin

S.P. Botkin State Hospital, Moscow

S.P. Botkin State Hospital, Moscow

E A Shakhnova

I.M. Sechenov First Moscow State Medical University, Moscow

I.M. Sechenov First Moscow State Medical University, Moscow

I A Dobrosmyslov

I.M. Sechenov First Moscow State Medical University, Moscow

I.M. Sechenov First Moscow State Medical University, Moscow

E M Shilov

I.M. Sechenov First Moscow State Medical University, Moscow

I.M. Sechenov First Moscow State Medical University, Moscow

S G Nesterova

I.M. Sechenov First Moscow State Medical University, Moscow

I.M. Sechenov First Moscow State Medical University, Moscow

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