Coagulation Disorders Study In The Elderly With Chronic Kidney Disease

Objective: To analysis the risk factors and prognosis of bleeding in the very old male patients with chronickidney disease ?CKD? stage 5.Methods: The clinical data of 143 very old male patients with CKD stage 5 were analyzed in this retrospective cohort study. According to the occurrence of bleeding,the patients were divided into two groups including the hemorrhage group and the non-hemorrhage group. The history, renal function, blood cell parameters and coagulation index were compared and analyzed between the two groups. The prognosis of patients with a period of 12 months was analyzed.Results: Among 143 cases of the patients, 67 cases ?about 46.85%? suffered bleeding,their mean age was ?88.99±4.53? years old. Other 76 patients ?about 53.15%? were without bleeding, their mean age was ?87.17±4.67? years old. The age ?88.99±4.53 vs 87.17±4.67, P=0.020?, pulmonary infection[22?32.84%? vs 7?9.21%?,P=0.000],blood systolic pressure ?145.74±15.80vs 138.5 ± 17.06,P=0.010??blood diastolic pressure?72.28±12.21 vs 66.49 ± 10.72,P=0.003?.plasma prothrombin time ?13.54 ± 1.02 vs 13.08±0.89,P=0.005 ? , activate part plasma prothrombin time ?40.86±8.02 vs 38.41 ±5.72,P=0.036??mean platelet volume ?10.23±1.35 vs 10.81 ± 1.57, P=0.021??fibrinogen ?4.09±0.75 vs 3.62±0.67,P=0.000??BUN ?37.19± 10.66 vs 32.86±8.97,P=0.009? were significantly increased in the hemorrhage group compared with the non-hemorrhage group ?P<0.05 or P<0.01?, Logistic regression analysis showed that the incidence of infection, lower levels of mean platelet volume, higher levels of fibrinogen , BUN and systolic blood pressure were the independent risk factors of bleeding in the male very old patients with CKD stage 5 ?P<0.05?. All the patients were followed up for 12 months, the number of all causes of death in the hemorrhage group at 3 months was significantly higher than that in the non-hemorrhage group, the number of recurrent bleeding events and recurrent major bleeding events were significantly higher than those in the non-hemorrhage group.Conclusion: old male patients with CKD stage 5 are prone to bleeding complications,and more possibilities to bleed again. Infection, average volume of blood platelet,fibrinogen, blood urea nitrogen, and systolic blood pressure were the independent risk factors of bleeding in the patients.Objective: To observe the effects and clinical significance of the changes of renal function on coagulation function and platelet function in the elderly patients.Methods: 1055 elderly outpatients in Chinese PLA General Hospital were enrolled from Jan.2015 to Dem.2015,all the patients were divided into three groups based on different estimated glomerular filtration rate?eGFR?,group A(eGFR ?90ml/min ·1.73m2 have 190 cases,their mean age were 67.64 ± 6.07 years old,including183 males and 7 females,group B(60 ml/min·1.73m2?eGFR<90 ml/min· 1.73m2=have 695 cases,their mean age were 73.24 ±11.35 years old,including 659 males and 36 females,group C?eGFR <60 ml/min·1.73m2?have 170 cases,their mean age were 84.49+ 6.59 years old,including 159 males and 11 females.The differences between three groups were analyzed through the blood cell parameters,coagulation index and thrombelastogram index.Results: Among the three groups,hemoglobin?148.91 ±9.39 vs 144.22± 12.89 vs133.14± 17.13,P=0.000?,blood platelet count?198.25 ±46.33 vs 184.54± 48.17 vs180.45± 51.75,P=0.001?,serum albumin?46.26± 2.1 vs 45.10± 2.6vs43.33 ± 3.4,P=0.000?,blood urea nitrogen?5.38 ± 1.26 vs 6.06 ± 1.45 vs 8.8 ± 3.56,P=0.000?,blood uric acid?344.62± 69.91 vs 348.39± 68.76 vs 380.51 ± 85.02,P=0.000?,serum high density lipoprotein?1.28 ± 0.31 vs 1.32 ± 0.66 vs 1.22± 0.37,P=0.002?were decreased with the deterioration of eGFR.Meanwhile,the coagulation index shows that plasma prothrombin time?12.73± 0.56 vs 12.98± 0.94 vs 13.29±1.17,P=0.000?,prothrombin activity mobility?111.53± 11.02 vs 107.66± 12.64 vs102.08 ± 12.6,P=0.000?,international normalized ratio?0.94+0.05 vs 0.97+0.09 vs1.00+0.12,P=0.000?,plasma fibrinogen?3.21 ± 0.48 vs 3.28± 0.55 vs 3.61 ± 0.76,P=0.000?,activated partial prothrombin time?35.13± 3.39 vs 35.24± 3.39 vs 36.64±4.5,P=0.000?were increased?P<0.01?with the decrease of eGFR.Thrombelastogram?TEG?index shows the R-value?6.51 ± 1.09 vs 6.2± 1.11 vs 6.03± 1.18,P=0.000?and K-value?1.96± 0₄5 vs 1.86± 0.44 vs 1.62± 0.46,P=0.000?were significantly shortened,alpha angle?62₄4± 5.34 vs 63.84± 5.27 vs 65.92±6₆7,P=0.000?was increased,MApiateiet?61.47± 4.29 vs 60.57± 4.27 vs 57.78± 5.9,P=0.000?was decreased?P<0.01?were significantly changed with the lower of eGFR.Pearson %2 analysis showed that the level of eGFR,hemoglobin,hematocrit,and serum albumin have a positive correlation with elevated MApiateiet,meanwhile,the level of blood urea nitrogen,serum creatinine,hypertension,coronary heart disease,myocardial infarction and aging had a negative correlation with the elevated MApiateiet.However,the multiple linear regression analysis showed that only the level of eGFR,hemoglobin,platelet hematocrit,serum albumin,serum total protein,diabetes were the independent risk factors of the elevated of MApiateiet.Conclusion: With the decrease of renal function,the platelet function decreased correspondingly.eGFR,hemoglobin,platelet hematocrit,serum albumin,serum total protein,diabetes were the independent risk factors of the elevated of MAplatelet...