THE MEASUREMENTS OF BLOOD CLOTTING IN CARDIORENAL SYNDROME IN ELDERLY

Aim. To assess the changes in hemocoagulation parameters according to the grade of renal dysfunction in elderly patients with cardiorenal syndrome types II and IV.

Material and methods. In 56 patients of the elderly age group (mean age 78±10 y.o.), with coronary heart disease and chronic heart failure, the parameters of blood clotting were assessed and the relations with kidney dysfunction grade measured by the level of glomerular filtration rate (GFR). Patients were selected to 3 groups. In 47 (83,9%) there was decline of GFR <60 mL/min/1,73 m2, of those in 8 (17,3%) <30 mL/min/1,73 m2; in 9 GFR >60 mL/min/1,73 m2, with no signs of proteinuria (16,1%). All patients underwent coagulological assessment of the blood with measurement of the activated partial thromboplastin time, thrombin time and prothrombin time, international normalized ratio and fibrinogen concentration, as the complete blood count with platelet number, mean platelet volume, thrombocyte distribution width, and thrombocrit.

Results. The number of platelets did differ significantly in groups 1 and 3 (p=0,040), as 2 and 3 (p=0,007). Thrombocrit values did differ significantly only in 2 and 3 (p=0,029). In the group 3 the rate of the mentioned values was below the respective reference values. Fibrinogen levels did differ significantly in groups 1 and 3 (p=0,042), and 2 and 3 (p=0,037). In the group 3 the parameter was higher than upper limit of reference range. Correlation found for GFR and fibrinogen level (r=-0,425; p=0,004), for GFR and platelet number (r=0,271; p=0,049). The platelet number correlated with creatinine level (ρ=-0,392; p=0,004). Creatinine level also correlated with fibrinogen level (ρ=0,375; p=0,012).

Conclusion. In the elderly, with the decline of GFR there is decline of thrombocyte number and increase of fibrinogen concentration together with an increase of the severity of kidney dysfunction. The pathological changes that were found might probably serve as additional factor influencing the risk of adverse events related to disorder of blood clotting. The importance of the revealed relations, as the aimfulness for clinical application, should be evaluated in controlled studies.

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2. Shevchenko OP, Prirodova OF. Atherosclerosis as a systemic inflammatory disease with a wavy and generalized activity of a process. Bulletin of RSMU 2010; 1: 28-33. (In Russ.)

3. Kobalava ZhD, Villevalde SV, Borovkova NYu, et al. Prevalence of Markers of Chronic Kidney Disease in Patients With Arterial Hypertension: Results of Epidemiological Study CHRONOGRAF. Russian Cardiology Journal 2017; 57 (10): 39-44. (In Russ.). DOI: 10.18087/cardio.2017.10.10041.

4. Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephro 2006; 17: 2034-47. DOI: 10.1681/ASN.2005101085.

5. Mi Y, Yan S, Lu Y, et al. Venous thromboembolism has the same risk factors as atherosclerosis. A PRISMA-compliant systemic review and meta-analysis. Medicine (Baltimore) 2016; 95 (32): e4495. DOI: 10.1097/MD.0000000000004495.

6. Shevchenko AO, Nikitina EA, Mozheiko NP, et al. Prevalence and predictors of hypertension in cardiac recipients. Russian journal of transplantology and artificial organs 2017; XIX, 3: 3-39. (In Russ.) DOI: 10.15825/1995-1191-2017-3-33-39.

7. McCullough PA. Cardiorenal Syndromes: Pathophysiology to Prevention. Int J Nephrol 2011; 762590. DOI:10.4061/2011/762590.

8. Huang M-J, Wei R-b, Wang Y, et al. Blood coagulation system in patients with chronic kidney disease: a prospective observational study. BMJ Open 2017; 7: e014294. DOI: 10.1136/bmjopen-2016-014294.

9. Ronco C, Di Lullo L. Cardiorenal syndrome in western countries: epidemiology, diagnosis and management approaches. Kidney Dis 2016; 2: 151-63. DOI: 10.1159/000448749.

10. Shevchenko OP, Prirodova OF. Atherosclerosis as a systemic inflammatory disease with a wavy and generalized activity of a process. Bulletin of RSMU 2010; 1: 28-33. (In Russ.)

11. Kobalava ZhD, Villevalde SV, Borovkova NYu, et al. Prevalence of Markers of Chronic Kidney Disease in Patients With Arterial Hypertension: Results of Epidemiological Study CHRONOGRAF. Russian Cardiology Journal 2017; 57 (10): 39-44. (In Russ.) DOI: 10.18087/cardio.2017.10.10041.

12. Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephro 2006; 17: 2034-47. DOI: 10.1681/ASN.2005101085.

13. Mi Y, Yan S, Lu Y, et al. Venous thromboembolism has the same risk factors as atherosclerosis. A PRISMA-compliant systemic review and meta-analysis. Medicine (Baltimore) 2016; 95 (32): e4495. DOI: 10.1097/MD.0000000000004495.

14. Shevchenko AO, Nikitina EA, Mozheiko NP, et al. Prevalence and predictors of hypertension in cardiac recipients. Russian journal of transplantology and artificial organs 2017; XIX, 3: 3-39. (In Russ.) DOI: 10.15825/1995-1191-2017-3-33-39.

15. McCullough PA. Cardiorenal Syndromes: Pathophysiology to Prevention. Int J Nephrol 2011; 762590. DOI:10.4061/2011/762590.

16. Huang M-J, Wei R-b, Wang Y, et al. Blood coagulation system in patients with chronic kidney disease: a prospective observational study. BMJ Open 2017; 7: e014294. DOI: 10.1136/bmjopen-2016-014294.