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Hypercoaguability in chronic kidney disease is associated with coagulation activation but not endothelial function


Adams, MJ and Irish, AB and Watts, GF and Oostryck, R and Dogra, GK, Hypercoaguability in chronic kidney disease is associated with coagulation activation but not endothelial function, Thrombosis Research, 123, (2) pp. 374-380. ISSN 0049-3848 (2008) [Refereed Article]

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DOI: doi:10.1016/j.thromres.2008.03.024


Introduction Patients with chronic kidney disease exhibit features of a hypercoagulable state and have endothelial dysfunction, which may contribute to their increased cardiovascular risk. We examined the relationship between coagulation activation and vascular function in patients with chronic kidney disease.

Materials and Methods We measured parameters of the tissue factor pathway of blood coagulation (tissue factor, factor VIIc and factor X); natural inhibitors (tissue factor pathway inhibitor, protein C, free and total protein S, antithrombin III) and markers of coagulation activation (thrombin-antithrombin complexes, prothrombin fragment 1 + 2) in 66 stage 4&5 chronic kidney disease patients and 36 healthy controls. Their relationship with markers of vascular function (flow mediated dilatation, soluble E-selectin and thrombomodulin) and a mediator of inflammation (interleukin-6) was determined.

Results Up-regulation of the tissue factor pathway (increased tissue factor and factor VIIc), increased prothrombin fragment 1 + 2 and significant reductions in antithrombin III and the ratio of free protein S: total protein S were found in patients compared to healthy controls. Increased tissue factor antigen was significantly and independently correlated with creatinine and interleukin-6 (P < 0.001). Factor X and antithrombin III were both reduced in chronic kidney disease and correlated (r = 0.58; P < 0.001). Changes in coagulation and anti-coagulation were independent of all measures of endothelial function.

Conclusions Significant activation of the TF pathway of coagulation and depletion or reduction of some natural anticoagulants in chronic kidney disease was correlated with the degree of renal dysfunction, but not correlated with the abnormalities of vascular function. These data are consistent with a hypercoagulable state in chronic kidney disease that may be independent of endothelial based regulation but associated with an inflammatory state.

Item Details

Item Type:Refereed Article
Keywords:blood coagulation, chronic kidney disease, endothelium, thrombin generation, tissue factor
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Haematology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Adams, MJ (Dr Murray Adams)
ID Code:52380
Year Published:2008
Web of Science® Times Cited:57
Deposited By:Health Sciences A
Deposited On:2008-07-02
Last Modified:2012-11-13

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