Assessment of haemostasis and impact of fibrinogen supplementation on clot properties using global haemostasis assays in patients on chronic dialysis

Background
Multifactorial haemostasis disorders are typical of patients with end-stage renal disease (ESRD) on chronic haemodialysis (HD). Thromboelastometry and impedance aggregometry allow for a comprehensive assessment of clot formation, lysis, and platelet (PLT) function. This study aims to determine the haemostatic profile in a group of patients with ESRD on chronic, interrupted dialysis, especially in terms of PLT function and the impact of in vitro fibrinogen concentrate supplementation on clot properties.

Methods
A total of 22 patients on chronic HD and 22 healthy controls (HC) were enrolled in the prospective study with a control group. Global haemostasis assays (GHA) were used to describe the haemostasis profile and to assess the effect of fibrinogen concentrate supplementation on improving clot quality.

Results
Despite the lack of considerable differences in the number of PLTs, there was a significantly lower potential of PLT aggregation in the HD group (922 ±163 AU*min). A higher concentration of fibrinogen was also observed in this group which presented considerably higher maximum clot firmness (MCF) FIBTEM (22 ±5.3 mm). Clotting time (CT) EXTEM was also prolonged (72 ±23 s). No hyperfibrinolysis was reported. In vitro fibrinogen concentrate supplementation resulted in significant improvement in MCF FIBTEM (30 mm vs. 22 mm; P < 0.001). However, it also led to a deterioration in PLT aggregation as assessed by TRAPtest.

Conclusions
The haemostasis profile of ESRD patients demonstrates a limited potential of PLT aggregation, with no improvement after fibrinogen addition.