Prevalence and associations for abnormal bleeding times in patients with renal insufficiency

Abstract

Platelet dysfunction and associated hemorrhagic complications are often encountered in patients with chronic kidney disease. This study aimed to evaluate the prevalence and associations for abnormal bleeding time (BT) in patients with renal dysfunction. Hemoglobin, hematocrit, platelet, blood urea nitrogen, creatinine, and parathyroid hormone levels were determined in 1716 patients (55.18 ± 17.19 years, men 50.8%). For these patients, BTs were estimated using a platelet function analyzer-100. Glomerular filtration rates (GFRs) were estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. The study population was divided into six groups according to the estimated GFR (eGRF): group I, eGFR ≥ 90 ml/min/1.73 m²; group II, 60 ≤ eGFR < 90 ml/min/1.73 m²; group III, 30 ≤ eGFR < 60 ml/min/1.73 m²; group IV, 15 ≤ eGFR < 30 ml/min/1.73 m²; group V, eGFR < 15 ml/min/1.73 m²; and group VI, undergoing regular hemodialysis. Renal insufficiency was defined as eGFR < 60 ml/min/1.73 m². To further investigate the role of inflammatory cytokines, nitric oxide (NO) and tumor necrosis factor alpha (TNF-α) were measured in a 327-patient subset of the total patient population (52.82 ± 18.3 years, men 60.9%). Abnormal BT occurred in 11.8% of group I, 15.3% of group II, 29.1% of group III, 37.5% of group IV, 35.0% of group V, and 32.1% of group VI. By Pearson correlation coefficient, eGFR (r = −0.089), hemoglobin (r = −0.127), platelet (r = −0.054) were correlated with BT. Multivariate analysis revealed that age [odds ratio (OR), 1.013; 95% CI, 1.004–1.022], renal insufficiency (eGFR < 60 ml/min/1.73 m²; OR, 2.271; 95% CI, 1.672–3.083), anemia (hemoglobin < 120 g/l; OR, 1.486; 95% CI, 1.089–2.027), and thrombocytopenia (platelet < 150 × 10⁹/l; OR, 1.445; 95% CI, 1.089–1.918) were independently associated with prolonged BT. Plasma levels of NO and TNF-α were increased in patients with renal insufficiency (eGFR < 60 ml/min/1.73 m²). Plasma levels of NO in renal insufficiency group were higher in prolonged BT than those in normal BT. A significant positive correlation was noted between BTs and NO levels (r = 0.152, p = 0.009) but not with TNF-α levels. The prevalence of abnormal BTs was higher as eGFR declined. Old age, renal insufficiency, anemia, and thrombocytopenia were independent associations for abnormal BT.

• Bleeding time
• PFA-100
• GFR
• NO

Declaration of interest: This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2011-0009743), by the Korea Science and Engineering Foundation through the Medical Research Center for Gene Regulation grant (2011-0030732) at Chonnam National University, and by a grant (CRI11085-1) from the Chonnam National University Hospital Research Institute of Clinical Medicine.