Changes Of Coagulation Function And Its Influencing Factors In Stages 3?5 Chronic Kidney Disease Patients

?Objective?To compare the changes in blood coagulation and investigate its influencing factors in patients with CKD 3⁵.?Methods?A total of 135 patients with CKD 3⁵ and 45 healthy persons who met the inclusion criteria were enrolled from January 2015 to June 2017.135 patients with CKD3⁵ were divided into 3 groups,each group included 45 patients.Blood coagulation indexes including prothrombin time?PT?,activated partial thromboplastin time?APTT?,thrombin time?TT?,fibrinogen?FIB?and d-dimer?D-D?were measured in CKD 3⁵ patients and healthy controls.According to the results of FIB,CKD 3⁵patients with FIB>4g/L were defined as hypercoagulable group and those with FIB?4g/L were defined as non-hypercoagulable group.Age,gender,body mass index?BMI?,mean arterial pressure?MAP?,smoking history,diabetes mellitus,coronary heart disease,estimated glomerular filtration rate?eGFR?,serum creatinine?Scr?,albumin?ALB?,total cholesterol?TC?,triglyceride?TG?,high-density lipoprotein?HDL?,low-density lipoprotein?LDL?,calcium(Ca²⁺),white blood cell?WBC?,haemoglobin?Hb?,platelet?PLT?,plateletocrit?PCT?,c-reactive protein?CRP?were compared between hypercoagulable group and non-hypercoagulable group.All the indexes were tested using univariate analysis,and those indexes which had statistically significant differences between the 2 groups were analyzed by multivariate logistic regression analysis.?Results?The levels of D-D,FIB and PT were significantly higher in CKD 3⁵ patients than those in the healthy controls and D-D and FIB were elevated with the decrease of eGFR?P<0.05?.The levels of D-D and FIB were statistically lower in CKD 3⁴patients than those in CKD 5 patients?P<0.05?.The proportion of coronary heart disease in hypercoagulable group was higher than those in non-hypercoagulable group?P<0.05?.The levels of Hb,HDL and eGFR were lower in hypercoagulable group than those in non-hypercoagulable group?P<0.05?.The levels of TC and Scr were higher in hypercoagulable group than those in non-hypercoagulable group?P<0.05?.In the 46patients with hypercoagulability,9 patients displayed CRP positive?19.57%?.In the 89patients with non-hypercoagulability,only 2 patients displayed CRP positive?2.24%?,with the statistical differences?P<0.05?.Univariate correlation analysis revealed that,serum FIB levels were positively correlated with Scr,CRP and coronary heart disease?r=0.713,0.327,0.219?,but were negatively correlated with Hb,eGFR and HDL?r=-0.327,-0.696,-0.188?.Logistic regression analysis showed that decrease in eGFR?OR=3.410,P<0.05?was an independent risk factor for hypercoagulability in patients with CKD 3⁵.?Conclusion?There is hypercoagulability in patients with CKD 3⁵ and the degree of hypercoagulability gradually aggravates with the decrease of eGFR.The proportion of coronary heart disease and CRP and the levels of TC and Scr were higher in hypercoagulable group than those in non-hypercoagulable group.The levels of Hb,HDL and eGFR were lower in hypercoagulable group than those in non-hypercoagulable group.Coronary heart disease,Hb,Scr,eGFR,TC,CRP and HDL may be influencing factors of hypercoagulability in patients with CKD 3⁵.Inflammation,dyslipidemia and renal damage are closely related to hypercoagulable state.Decrease in eGFR may be an independent risk factor for hypercoagulability in CKD 3⁵ patients.