Changes in the expression of novel coagulation and fibrinolytic markers in chronic kidney disease

Abstract:

Objective To investigate the changing trend of the expression of plasma coagulation and fibrinolytic markers in patients with chronic kidney disease（CKD），and to provide a basis for the diagnosis and treatment of CKD-related coagulopathies.Methods According to the inclusion criteria，123 patients with CKD were selected from the CKD patients who attended Shaanxi Provincial Hospital of Traditional Chinese Medicine from May 2021 to May 2022，and they were divided into groups based on estimated glomerular filtration rate；40 healthy controls（HCs） were selected from the individuals who underwent physical examination and were established as HC group. Related coagulation and fibrinolytic markers were measured，i.e.，thrombomodulin（TM），thrombin-antithrombin complex （TAT），fibrin-α2 antifibrinolytic complex（PIC），tissue-type fibrinogen activator inhibitor-1 complex（t-PAIC），prothrombin time （PT），activated partial thromboplastin time（APTT），thrombin time （TT），fibrinogen（FIB），fibrinogen degradation product（FDP），and D-dimer（DD），as well as the expression levels of albumin，serum creatinine（SCr），and blood urea nitrogen（BUN）.Results There were no significant differences in PT，APTT，and TT between groups（P>0.05），and the CKD group had significantly higher FIB，DD，and TAT than the HC group （P<0.001）. The level of DD in stage 5 CKD was significantly higher than that in stage 1/2 CKD（P<0.05）. The level of FDP in stage 2-5 CKD was significantly higher than that in the HCs（P<0.05），and the level of FDP in stage 5 CKD was significantly higher than that in stage 1/2 CKD. PIC in stage 3-5 CKD was significantly higher than that in the HCs，and PIC in stage 4 CKD was significantly higher than that in stage 1/2 CKD（P<0.001）. The level of t-PAIC in stage 1-4 CKD was significantly higher than that in the HCs（P<0.05）. TM in stage 2-5 CKD was significantly higher than that in the HCs，and TM in stage 4-5 CKD was significantly higher than that in the other stages（P<0.001）. The CKD groups had a significantly higher TAT/PIC ratio than the HC group，with a significant difference between stage 1-3 CKD and the HCs（P<0.001）. The receiver operating characteristic（ROC） curve analysis of TAT/PIC ratio showed an area under the ROC curve of 0.716 in differentiating CKD from HCs.Conclusion Hypercoagulability is prevalent in CKD patients，and novel coagulation markers have a good ability to reflect the changes in coagulation function.