The Clinical Investigations Of Hemorrhage And Coagulation In Patients With End Stage Renal Disese

ObjectiveThe patients with end stage renal disease (ESRD) always have disorders of hemorrhage and coagulation. There are often simultaneously two kinds of mutually contradictory tendencies clinically, which are hypercoagulation and hemorrhage. Because of reduced erythrocyte hemotocript or decending adhesion and aggregation of thrombocyte or abnormality of vessel wall, bleeding time of patient prolonged and it is easy to bleed. Meanwhile microembolism is commom due to actived coagulation factors and reduced fibrolysis.In this study, some common coagulation indice and thrombocyte parameters were monitored in patients with ESRD, and changes of coagulation and fibrolysis in patients with or without haemodialysis, as well as influence of the age and sex,were studied in order to present laborotery data for embolism and hemorrhage.Methods60 patients with ESRD and 30 healthy adults were included in this study. We determined the PLT(platelet),MPV(mean platelet volume),PDW(platelet distribution width),PT(prothrombin time),APTT(active part thrombin time),TT(thrombin time),FIB(fibrinogen),D-D(D-Dimmer),blood clot constraction test and coloured ultrasonic examination on lower limb blood vessel. None of the subjects in any group had a history of cardiovascular disease or solid cancer or blood tumor.All data were managed using SPSS13.0 for statistics。Parametric data were expressed as mean±SD. Comparisons of means were performed with Independent-Samples t-Test or One-Way ANOVA. Group comparison of categorical variable was performed by chi square test-fourfold table precise probabilistic method. Influential factor was performed by binary Logistic regessin analysis. The relationships between parameters were analyzed by Pearson correlation coefficient.P value<0.05 was considered statistically significant.Results1. Comparison between study group and control group.(1)t test was used for PLT, PT and Fib in both groups. t value was 3.44,6.63,3.25, respectively, all P were<0.01, and there is statistical significance. See Table 1.(2) There were no D-D positive cases in control group while 36 in study group accounting for 60%.(3) 24 hour blood clot constraction test in all cases was complete, showing that it was not sensitive in platelet disfunction.(4) There were no vein embolisms by ultrosonic examination in both groups.2. Comparison between Groups with or without hemodialysis and among control group, nonhemodialysis group and hemodialysis group.(1) PLT, APTT, PT and TT in nonhemodialysis group were reduced evidently yet FIB rinsed compared with those in control group. PLT and PT in hemodialysis group descended evidently yet FIB elevated evidently compared with those in control group. APTT in hemodialysis group was shortened evidently compared with that in nonhemodialysis group. See Table 2.(2) PLT and PT in hemodialysis group and nonhemodialysis group were shortened evidently yet FIB was raised. See Table 2.(3) FIB in ESRD patients both with and without hemodialysis was raised evidently P<(0.01). See Table 2.(4) D-D of 22 cases in nonhemodialysis group was positive, accounting for 57.89%, while 12,in hemodialysis group, accounting for 54,55%,χ2=10.29, P<0.01. There is statistical significance.3. According to age, all cases were divided into young, mid-aged and old groups. There were no significantly statistical differences about PLT,MPV,PDW,APTT,PT,TT and FIB among the three groups. See Table 3.4. According to sex (1)PLT,MPV,PDW,APTT,PT and FIB in male group were compared with those in female group, t value was 0.0274,0.0084,0.1286,0.1002,0.7704and 0.0551, all P<0.05. There were no statistical significances.(2) D-D was positive in 28 male cases, accounting for 60.87%; while in 8 female, accounting for 57.14%,χ2=8.062, P<0.01. There is statistical significance.5.24 hour blood clot constraction was completed in all cases.6. Ultrasonic examination on lower limb vein of all subjects revealed absence of embolism.Conclusions1.Bleeding tendency and hypercoagulation exist in patients with ESRD at the same time.2. Maitainence hemodialysis could not improve hypercoagulation effectively.3. The age has no effect on patient with ESRD.4. The sex has no effect,too.5. D-Dimer test is valuable.6.Blood clot constraction test is not sensitive in ESRD patients.7.,Low limb vein embolism incidence is low in ESRD patients.