Impact of Hemodialysis on Bleeding Tendency in End Stage Renal Disease Patients

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Mohamed A. Abdelrahman
Samia El-Shishtawy
Anas Ibrahim
Ola Mahmoud
Ola Aboelnil
Maha A. Saied
Ahmed Abdulmajid
Omar M. Sabry


Bleeding tendency - D-dimer - fibrinogen - hemodialysis-ESRD- heparin free dialysis


Background: Heparin is a potent anticoagulant with diverse pleiotropic effects through cytokine release. In hemodialysis, anticoagulation using systemic heparinization is crucial to prevent blood clots within the extracorporeal circuit. However, the risk of bleeding complications and substantial hemostatic defects are increased in maintenance HD patients.
Aim of work: the aim of the presented study was to investigate the effect of systemic heparinization during hemodialysis on the coagulation profile of maintenance HD patients and whether heparin free dialysis would be beneficial for specific patients.
Patients and Methods: Sixty ESRD patients on regular HD three times per week and 25 healthy controls were recruited to this study. Complete blood count, prothrombin time, activated partial prothrombin time, fibrinogen and D-dimer levels pre and post hemodialysis were evaluated.
Results: The presented study demonstrated prolongation of PTand APTT associated with increased levels of fibrinogen and D- dimer post HD (p-value: <0.0001).
Conclusion: The prolonged PT and APTT in addition to the rise in fibrinogen and D- dimer levels post HD indicates that the prophylactic anticoagulantion using unfractionated heparin could increase the risk of bleeding in HD patients.

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1. Suwitra K, Sudoyo AW, Setiyohadi B, Alwi I, Marcellus SK and Setiati S (2006): 4th Ed. Jakarta, Pusat Penerbitan Departemen Ilmu Penyakit Dalam FKUI, p 570-3
2. Friberg L, Benson L, Lip GH (2015): Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: The Swedish Atrial Fibrillation Cohort study. Eur Heart J. 2015; 36:297-306.
3. Molnar AO, Bota SE, Garg AX (2016): The risk of major hemorrhage with CKD. J Am Soc Nephrol.;27:2825-2832.
4. Mohamed Ali MS, Babiker MA, Merghani LB, Ali FA (2008): Hematological Changes Post-Hemo and Peritoneal Dialysis Among Renal Failure Patients in Sudan. Saudi J Kidney Dis Transpl;19: 274-79.
5. Hernaningsih Y, Widodo M, Aprianto K (2019): Comparison Of Ppt And Aptt In Pre And Post-Hemodialysis Patients As The Heparin-Exposed Effect. Fol Med Indones, Vol. 55 No. 3 September: 166-170
6. Kim YG (2003): Anticoagulation during hemodialysis patients at high-risk of bleeding Nephrology, 23-27
7. Dara KM (2009): Effect of hemodialysis and peritoneal dialysis on some hematological and biochemical parameters in renal failure. Zanjo J. Med 13
8. Lohr JW and Schwab SJ (2008): Minimizing hemorrhagic complication in dialysis patients. Journal of the American Society of Nephrology 2, 961-75
9. Prasanto H (2007): Hypercoagulation in chronic kidney disease. The 7th Jakarta Nephrology & Hypertension Course. PERNEFRI, 25-27 10. Pereira R, Costa E, Gonçalves M, Miranda V, Sameiro Faria M, Quintanilha A, Belo L, Lima M, Santos-Silva A (2010). Neutrophil and monocyte activation in chronic kidney disease patients under hemodialysis and its relationship with resistance to recombinant human erythropoietin and to the hemodialysis procedure. Hemodial Int. 14(3): 295-301.
11. Mohamed AMS, Babiker MA, Merghani LB, Al Taib Ali FA, Abdulmajeed MH (2008). Hematological changes post-hemo and peritoneal dialysis among renal failure patients in Sudan. Saudi J. Kidney Dis. Transpl., 19(2): 274-279.
12. Ulusoy S, Ovali E, Aydin F, Erem C, Ozdemir F, Kaynar K (2004). Hemostatic and fibrinolytic response to nasal desmopressin in hemodialysis patients. Med. Princ. Pract.,13(6): 340-5.
13. Ciaccio M, Bivona G, Di Sciacca R, Iatrino R, Di Natale E, Li Vecchi M, Bellia C (2008). Changes in serum fetuin-A and inflammatory markers levels in end stage renal disease (ESRD): effect of a single session haemodialysis. Clin. Chem. Lab. Med., 46(2): 212-4
14. Alghythan A. K, and Alsaeed A. H. (2012). Hematological changes before and after hemodialysis. Scientific Research and Essays Vol. 7(4), pp. 490-497, 30 January 2012
15. Gackler A, Rohn H, Lisman T, Benko¨ T, Witzke O, Kribben A, Saner F (2019) Evaluation of hemostasis in patients with end-stage renal disease. PLoS ONE 14(2): 212-237
16. Attika Khalid and Lubna Zafar (2015). Effect of Hemodialysis on Mean Prothrombin Time and Activated Partial Thromboplastin Time in Patients of End Stage Renal Disease. Journal of Rawalpindi Medical College (JRMC);2015;19(3):247-249
17. Derry Heppy Fritiwi, Harun Rasyid Lubis, Adi Koesoema Aman, Herman Hariman (2019). D-Dimer In Hemodialysis Patients Receiving Continuous And Intermittent Heparin. Indonesian Journal of Clinical Pathology and Medical Laboratory, 2019 July, 25 (3): 307 – 311
18. Daugirdas J and Bernardo A (2012). Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney International (2012) 82, 147–157

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