Bleeding problems are common in people with kidney disease

People with chronic kidney disease (CKD) are more likely to experience problems with bleeding and are also more likely to develop blood clots in their arteries and veins. It is vital to understand a patient’s risk of either bleeding or clotting before performing a number of medical procedures, but the standard clinical tests cannot accurately detect this.

There are new tests available that are better at measuring how ‘sticky’ blood is, and how likely someone is to bleed, but they have previously not been tested in kidney patients.

Using novel tests to measure how ‘sticky’ blood is

With our funding and funding from the British Society of Haematology, the Missions Sector-Ministry of Higher Education, Egypt and the Newton-Mosharafa program, a team of researchers from London, UK, and Alexandria, Egypt, led by Dr Kate Bramham from King’s College London studied whether these novel tests could be used to assess bleeding and clotting risk in kidney patients.

The team took blood samples from 30 healthy individuals and 120 patients with kidney disease: ten patients with stage 2 CKD (mild disease), 20 with stage 3 CKD (moderate disease), 20 with stage 4 CKD (advanced disease), 20 with stage 5 CKD not requiring renal replacement therapy (very advanced disease), 20 patients with kidney transplants, ten patients who had recently started on haemodialysis (HD) and 20 patients who had been on HD for a while.

Researchers performed the standard laboratory tests as well as a number of new tests, including a technique that measures clot formation in blood samples (called rotational thromboelastometry), a technique that measures the function of platelets – small particles which help blood to clot (called multiple electrode aggregometry), a method to measure a protein called thrombin – a clotting factor that maintains the balance between bleeding and clotting (thrombin generation assays), and a number of other measures.

The team found that patients with kidney disease were more likely to have ‘stickier’ blood – measured by blood clot strength – than healthy individuals. They also found that people with very advanced kidney disease, including those on dialysis, had problems with their platelets which meant clots did not form as well as in healthy individuals. The clots formed from blood samples from these patients were also slower to break down than clots from health individuals.

What could this mean for patients?

Kate explained: “We think that these new tests could be used to work out which patients are more likely to have blood clots, so that blood thinning treatment can be given before procedures such as forming a new fistula. The tests could also identify which patients are more likely to bleed during invasive procedures such as kidney biopsies, so that treatment to improve platelet function can be given.”