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Medical Studies/Studia Medyczne
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2/2023
vol. 39
 
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abstract:
Original paper

Coagulation abnormalities as predictors of renal dysfunction in heart failure with reduced ejection fraction

Paula Połaska
1
,
Ilona Kowalik
2
,
Katarzyna Kozar-Kamińska
3
,
Elżbieta Górska
4
,
Urszula Demkow
4
,
Przemysław Leszek
1
,
Piotr Rozentryt
5, 6
,
Tomasz Zieliński
1
,
Anna Drohomirecka
1
,
Tomasz Rywik
1

  1. Heart Failure and Transplantology Department, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
  2. Department of Coronary Artery Disease and Cardiac Rehabilitation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
  3. Laboratory of Immunology, Department of Medical Biology, Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
  4. Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
  5. 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
  6. Silesian Centre for Heart Disease, Zabrze, Poland
Medical Studies/Studia Medyczne 2023; 39 (2): 148–158
DOI: https://doi.org/10.5114/ms.2023.129035
Online publish date: 2023/06/30
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Introduction
Heart failure (HF) is a prothrombotic state that is also associated with the progression of renal dysfunction. However, it is unknown whether coagulation abnormalities are associated with progressive cardiorenal syndrome.

Aim of the research
To evaluate activators and inhibitors of coagulation and fibrinolysis and their relationship with renal failure in HF patients.

Material and methods
Coagulation biomarkers such as thrombin-antithrombin III, human tissue-type plasminogen activator, human plasminogen activator inhibitor, von Willebrand factor (vWF), soluble thrombomodulin (sTM), human prothrombin fragments (F1+F2), and protein C were evaluated in 36 consecutive HF patients without anticoagulation and in 19 controls matched in age and gender.

Results
HF patients, compared to controls, had lower levels of C protein (p = 0.04) and F1 + F2 (p < 0.001) but higher levels of vWF (p < 0.001) and borderline sTM (p = 0.07). Similarly, haemoglobin (p < 0.001) and glomerular filtration rate (GFR) (p = 0.004) were lower in HF, while INR (p < 0.001), NT-proBNP (p < 0.001), and asymmetric dimethylarginine (ADMA) (p < 0.001) were higher. Most of the echocardiographic parameters differed between the 2 groups. From coagulation biomarkers, sTM (r = –0.66; p < 0.001) and vWF (r = –0.41; p = 0.002) were associated with eGFR. Most of the echocardiographic and laboratory parameters were also related to eGFR. After classifying all variables into 5 categories; laboratory tests, echocardiographic parameters, vascular reactivity, haemodynamics, and coagulation parameters, multivariable linear regression showed that coagulation parameters were the most strongly associated with eGFR (r2 = 0.48, p < 0.001).

Conclusions
In the study population, coagulation disorders were most strongly associated with impaired renal function, independently of other parameters.

keywords:

coagulation abnormalities, heart failure, renal dysfunction
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