Impact of renal replacement therapy modality on coagulation and platelet function in critically ill patients: A prospective observational study.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 7802778 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1594 (Electronic) Linking ISSN: 0160564X NLM ISO Abbreviation: Artif Organs Subsets: MEDLINE
    • Publication Information:
      Publication: Cambridge, MA : Wiley-Blackwell
      Original Publication: Cleveland, International Society for Artificial Organs.
    • Subject Terms:
      Critical Illness* ; Blood Coagulation* ; Renal Dialysis*/methods ; Renal Dialysis*/adverse effects ; Thrombelastography*; Humans ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged ; Platelet Aggregation ; Blood Platelets ; Platelet Function Tests ; Renal Replacement Therapy/methods ; Renal Replacement Therapy/adverse effects ; Continuous Renal Replacement Therapy/methods ; Adult ; Blood Coagulation Tests
    • Abstract:
      Background: Renal replacement therapy (RRT) may affect coagulation and platelet function in critically ill patients. However, the mechanism and the difference in the impact on coagulation between intermittent hemodialysis (iHD) and continuous renal replacement therapy (CRRT) remains unclear. This study aimed to investigate and compare the impact of iHD and CRRT on coagulation and platelet function.
      Methods: Critically ill patients undergoing RRT were classified into the iHD group or the CRRT group. After the first blood sampling, patients underwent either a single session of hemodialysis or 48 h of CRRT, then a second blood sample was taken. Rotational thromboelastometry (ROTEM), platelet aggregometry and conventional coagulation tests were performed. The primary outcome was a change in extrinsically activated ROTEM (EXTEM) clotting time (CT).
      Results: 60 dialysis sessions from 56 patients were finally included, with 30 dialysis sessions per group. EXTEM CT was prolonged significantly after dialysis in the iHD group (90 [74, 128] vs. 74 [61, 91], p < 0.001), but did not change in the CRRT group (94.4 ± 29.4 vs. 91.6 ± 22.9, p = 0.986). The platelet aggregation did not change after both iHD and CRRT. A change in EXTEM CT was significantly greater in the iHD group compared to the CRRT group (p = 0.006). The difference in the incidence of bleeding events was insignificant between the two groups (p = 0.301).
      Conclusions: EXTEM CT was significantly prolonged after iHD, but this change was not shown after CRRT. Platelet function was not affected by both dialysis modalities.
      (© 2024 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
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    • Grant Information:
      03-2020-0310 Seoul National University Hospital
    • Contributed Indexing:
      Keywords: coagulation; continuous renal replacement therapy; critically ill; hemodialysis; platelet function; renal replacement therapy
    • Publication Date:
      Date Created: 20240920 Date Completed: 20241231 Latest Revision: 20250104
    • Publication Date:
      20250104
    • Accession Number:
      PMC11687214
    • Accession Number:
      10.1111/aor.14872
    • Accession Number:
      39301818