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Practical Nephrology pp 603–612Cite as

Coagulation in Kidney Disease

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Abstract

Patients with acute kidney injury or chronic kidney disease exhibit dysfunction of normal haemostasis. The spectrum of abnormalities is wide, often including simultaneously a bleeding diathesis and prothrombotic tendency. Practical management of patients from first presentation to those on long term renal replacement therapy should include assessment of the balance between bleeding and thrombotic risk, along with an understanding how haemostatic or anticoagulant therapy may affect this balance.

This chapter provides an overview of current understanding of normal haemostasis and outlines the mechanisms underlying uraemic bleeding. Detailed attention is given to the management of bleeding in renal patients, as well as venous thrombosis and anticoagulation. In addition, a focus on heparin-induced thrombocytopenia (HIT) is provided, along with practial guidance on its diagnosis and management in patients requiring renal replacement therapy.

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References

  1. Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ. Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol. 2007;3(3):138–53. doi:10.1038/ncpneph0421.

    Article  CAS  PubMed  Google Scholar 

  2. Noris M, Remuzzi G. Uremic bleeding: closing the circle after 30 years of controversies?. Blood. 1999;94(8):2569–74. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10515859.

  3. Sohal AS, Gangji AS, Crowther MA, Treleaven D. Uremic bleeding: pathophysiology and clinical risk factors. Thromb Res. 2006;118(3):417–22. doi:10.1016/j.thromres.2005.03.032.

    Article  CAS  PubMed  Google Scholar 

  4. Sood P, Kumar G, Nanchal R, Sakhuja A, Ahmad S, Ali M, et al. Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. Am J Nephrol. 2012;35(3):216–24. doi:10.1159/000336107.

    Article  CAS  PubMed  Google Scholar 

  5. Yang J-Y, Lee T-C, Montez-Rath ME, Paik J, Chertow GM, Desai M, et al. Trends in acute nonvariceal upper gastrointestinal bleeding in dialysis patients. J Am Soc Nephrol. 2012;23(3):495–506. doi:10.1681/ASN.2011070658.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Ohmori T, Konishi H, Nakamura S, Shiratori K. Abnormalities of the small intestine detected by capsule endoscopy in hemodialysis patients. Intern Med. 2012;51(12):1455–60. doi:10.2169/internalmedicine.51.7190.

    Article  PubMed  Google Scholar 

  7. Power A, Hamady M, Singh S, Ashby D, Taube D, Duncan N. High but stable incidence of subdural haematoma in haemodialysis–a single-centre study. Nephrol Dial Transplant. 2010;25(7):2272–5. doi:10.1093/ndt/gfq013.

    Article  PubMed  Google Scholar 

  8. Anderson RJ, O’brien M, MaWhinney S, VillaNueva CB, Moritz TE, Sethi GK, et al. Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery. VA Cooperative Study #5. Kidney Int. 1999;55(3):1057–62. doi:10.1046/j.1523-1755.1999.0550031057.x.

    Article  CAS  PubMed  Google Scholar 

  9. Corapi KM, Chen JLT, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis. 2012;60(1):62–73. doi:10.1053/j.ajkd.2012.02.330.

    Article  PubMed  Google Scholar 

  10. Manno C, Strippoli GFM, Arnesano L, Bonifati C, Campobasso N, Gesualdo L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int. 2004;66(4):1570–7. doi:10.1111/j.1523-1755.2004.00922.x.

    Article  PubMed  Google Scholar 

  11. Manno C, Bonifati C, Torres DD, Campobasso N, Schena FP. Desmopressin acetate in percutaneous ultrasound-guided kidney biopsy: a randomized controlled trial. Am J Kidney Dis. 2011;57(6):850–5. doi:10.1053/j.ajkd.2010.12.019.

    Article  CAS  PubMed  Google Scholar 

  12. Steiner RW, Coggins C, Carvalho AC. Bleeding time in uremia: a useful test to assess clinical bleeding. Am J Hematol. 1979;7(2):107–17. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/539588.

  13. Zupan IP, Sabovic M, Salobir B, Ponikvar JB, Cernelc P. Utility of in vitro closure time test for evaluating platelet-related primary hemostasis in dialysis patients. Am J Kidney Dis. 2003;42(4):746–51. doi:10.1053/S0272-6386(03)00913-2.

    Article  PubMed  Google Scholar 

  14. Warkentin TE, Chong BH, Greinacher A. Heparin-induced thrombocytopenia: towards consensus. Thromb Haemost. 1998;79(1):1–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9459312.

  15. Pavord S, Myers B. Bleeding and thrombotic complications of kidney disease. Blood Rev. 2011;25(6):271–8. doi:10.1016/j.blre.2011.07.001.

    Article  PubMed  Google Scholar 

  16. Singhal R, Brimble KS. Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management. Thromb Res. 2006;118(3):397–407. doi:10.1016/j.thromres.2005.03.030.

    Article  CAS  PubMed  Google Scholar 

  17. Mahmoodi BK, Ten Kate MK, Waanders F, Veeger NJGM, Brouwer J-LP, Vogt L, et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study. Circulation. 2008;117(2):224–30. doi:10.1161/CIRCULATIONAHA.107.716951.

    Article  PubMed  Google Scholar 

  18. Barratt J, Topham P, Harris K, editors. Nephrotic syndrome. In: Oxford desk reference: nephrology. 1st ed. Oxford, UK: Oxford University Press; 2009. p. 84.

    Google Scholar 

  19. Glassock RJ. Prophylactic anticoagulation in nephrotic syndrome: a clinical conundrum. J Am Soc Nephrol. 2007;18(8):2221–5. doi:10.1681/ASN.2006111300.

    Article  PubMed  Google Scholar 

  20. Knoll GA, Wells PS, Young D, Perkins SL, Pilkey RM, Clinch JJ, et al. Thrombophilia and the risk for hemodialysis vascular access thrombosis. J Am Soc Nephrol. 2005;16(4):1108–14. doi:10.1681/ASN.2004110999.

    Article  PubMed  Google Scholar 

  21. Osborn G, Escofet X, Da Silva A. Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts. Cochrane Database Syst Rev (Online). 2008;(4):CD002786. doi:10.1002/14651858.CD002786.pub2.

  22. Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA. 2008;299(18):2164–71. doi:10.1001/jama.299.18.2164.

    Article  CAS  PubMed  Google Scholar 

  23. Olesen JB, Lip GYH, Kamper A-L, Hommel K, Køber L, Lane DA, et al. Stroke and bleeding in atrial fibrillation with chronic kidney disease. N Engl J Med. 2012;367(7):625–35. doi:10.1056/NEJMoa1105594.

    Article  CAS  PubMed  Google Scholar 

  24. Schmid P, Fischer AG, Wuillemin WA. Low-molecular-weight heparin in patients with renal insufficiency. Swiss Med Wkly. 2009;139(31–32):438–52. smw-11284.

    CAS  PubMed  Google Scholar 

  25. Palmer SC, Di Micco L, Razavian M, Craig JC, Perkovic V, Pellegrini F, et al. Effects of antiplatelet therapy on mortality and cardiovascular and bleeding outcomes in persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med. 2012;156(6):445–59. doi:10.1059/0003-4819-156-6-201203200-00007.

    Article  PubMed  Google Scholar 

  26. Wattanakit K, Cushman M. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms. Curr Opin Pulm Med. 2009;15(5):408–12. doi:10.1097/MCP.0b013e32832ee371.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Sandset PM. CXCL4-platelet factor 4, heparin-induced thrombocytopenia and cancer. Thromb Res. 2012;129(Suppl):S97–100. doi:10.1016/S0049-3848(12)70026-9.

    Article  CAS  PubMed  Google Scholar 

  28. Amiral J, Bridey F, Dreyfus M, Vissoc AM, Fressinaud E, Wolf M, Meyer D. Platelet factor 4 complexed to heparin is the target for antibodies generated in heparin-induced thrombocytopenia. Thromb Haemost. 1992;68(1):95–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1514184.

  29. Kelton JG, Warkentin TE. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008;112(7):2607–16. doi:10.1182/blood-2008-02-078014.

    Article  CAS  PubMed  Google Scholar 

  30. Warkentin TE. How I diagnose and manage HIT. Hematology Am Soc Hematol Educ Program. 2011;2011:143–9. doi:10.1182/asheducation-2011.1.143.

    Article  PubMed  Google Scholar 

  31. Warkentin TE. Hemodialysis-associated acute systemic reactions and heparin-induced thrombocytopenia. Thromb Res. 2012;129(4):405–6. doi:10.1016/j.thromres.2011.11.004.

    Article  CAS  PubMed  Google Scholar 

  32. Davenport A. Sudden collapse during haemodialysis due to immune-mediated heparin-induced thrombocytopaenia. Nephrol Dial Transplant. 2006;21(6):1721–4. doi:10.1093/ndt/gfl124.

    Article  PubMed  Google Scholar 

  33. Arepally GM, Ortel TL. Clinical practice. Heparin-induced thrombocytopenia. N Engl J Med. 2006;355(8):809–17.

    Article  CAS  PubMed  Google Scholar 

  34. Syed S, Reilly RF. Heparin-induced thrombocytopenia: a renal perspective. Nat Rev Nephrol. 2009;5(9):501–11. doi:10.1038/nrneph.2009.125.

    Article  PubMed  Google Scholar 

  35. Asmis LM, Segal JB, Plantinga LC, Fink NE, Kerman JS, Kickler TS, et al. Heparin-induced antibodies and cardiovascular risk in patients on dialysis. Thromb Haemost. 2008;100(3):498–504. doi:10.1160/TH08-03-0144.

    CAS  PubMed  Google Scholar 

  36. Warkentin TE, Greinacher A, Gruel Y, Aster RH, Chong BH. Laboratory testing for heparin-induced thrombocytopenia: a conceptual framework and implications for diagnosis. J Thromb Haemost. 2011;9(12):2498–500. doi:10.1111/j.1538-7836.2011.04536.x.

    Article  CAS  PubMed  Google Scholar 

  37. Cuker A, Cines DB. How I treat heparin-induced thrombocytopenia. Blood. 2012;119(10):2209–18. doi:10.1182/blood-2011-11-376293.

  38. Pouplard C, Gueret P, Fouassier M, Ternisien C, Trossaert M, Régina S, et al. Prospective evaluation of the “4Ts” score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparininduced thrombocytopenia. J Thromb Haemost. 2007;5(7):1373–9.

    Google Scholar 

  39. Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. The Am J Med. 1996;101(5):502–7. Retrieved from http://www.sciencedirect.com/science/article/pii/S0002934396002586.

  40. Linkins L-A, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e495S–530. doi:10.1378/chest.11-2303.

    CAS  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK

    Duncan Brian MBBS, MRCS, MRCP (Lond) & Pratima Chowdary MBBS, FRCPath

Authors
  1. Duncan Brian MBBS, MRCS, MRCP (Lond)
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  2. Pratima Chowdary MBBS, FRCPath
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Corresponding author

Correspondence to Pratima Chowdary MBBS, FRCPath .

Editor information

Editors and Affiliations

  1. UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, United Kingdom

    Mark Harber

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© 2014 Springer-Verlag London

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Brian, D., Chowdary, P. (2014). Coagulation in Kidney Disease. In: Harber, M. (eds) Practical Nephrology. Springer, London. https://doi.org/10.1007/978-1-4471-5547-8_53

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  • DOI: https://doi.org/10.1007/978-1-4471-5547-8_53

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  • Print ISBN: 978-1-4471-5546-1

  • Online ISBN: 978-1-4471-5547-8

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