Kotliarova G V, Kozlovskaia N L, Lashutin S V, Komiagin Iu V, Shakhnova E A, Dobromyslov I A, Shilov E M, Nesterova S G
Ter Arkh. 2011;83(6):36-41.
To evaluate parameters of hemostasis system in patients with end-stage renal disease (ESRD) with consideration of elective or urgent start of dialysis treatment.
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).
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.
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.
考虑到透析治疗是择期还是紧急开始，评估终末期肾病（ESRD）患者的止血系统参数。
共有47例ESRD患者进入本研究。根据血液透析是紧急开始（第1组）还是择期开始（第2组）将他们分为两组。第1组由31例患者（13例女性，18例男性）组成，年龄在18 - 86岁之间；第2组由16例患者（9例女性，7例男性）组成，年龄在36 - 79岁之间。两组患者在ESRD病因方面具有可比性。比较了临床和实验室检查结果：活化部分凝血活酶时间、凝血酶原时间、纤维蛋白原水平、可溶性纤维蛋白 - 单体复合物（SCFM）。
氮质血症、高钾血症和贫血情况相近。第1组患者的营养状况和脂肪代谢改变更严重，有明显的水钠潴留和血容量过多、动脉高血压、更频繁的神经和感染并发症以及肠炎症状。第1组血栓形成并发症发生率为51.5%，血管通路血栓形成率为45%；而第2组仅出现一种血栓形成并发症——原发性动静脉内瘘血栓形成（1例患者，6.25%）。第2组无出血并发症，第1组出血并发症的发生率比血栓形成少5倍。第1组的血小板计数显著低于第2组（p = 0.001）。第1组约65%的患者出现高纤维蛋白原血症，第2组为46%。两组SCFM水平均升高，但第1组比第2组高50%（p = 0.005）。这表明紧急血液透析患者的血管内凝血激活更强。
与择期血液透析患者相比，因紧急血液透析入院的ESRD患者尿毒症综合征更严重，凝血激活更强。紧急血液透析患者的血栓形成频率比择期血液透析患者高8.3倍。
