The hypercoagulability paradox of chronic kidney disease: The role of fibrinogen

Am J Surg. 2017 Dec;214(6):1215-1218. doi: 10.1016/j.amjsurg.2017.08.039. Epub 2017 Sep 18.


Background: Chronic kidney disease (CKD) patients have increased rates of bleeding as well as thrombosis. Fibrinogen and platelets combine to generate a mature clot, but in CKD platelets are dysfunctional. Therefore, we hypothesize that CKD patients have increased clot strength due to elevated fibrinogen levels.

Methods: Retrospective review of CKD patients (n = 84) who had rTEG and fibrinogen levels measured. They were compared to healthy controls (n = 134).

Results: CKD patients had statistically significant increases in ACT, angle, MA and decreases in LY30 compared to controls. Fibrinogen levels were increased in CKD patients compared to reference range. Fibrinogen levels had a positive correlation with MA (rho = 0.709, p < 0.0001) in CKD patients.

Conclusions: Patients with CKD manifest a coagulopathy consisting of delayed clot formation, but increased final clot strength and decreased clot breakdown. Furthermore, the elevated clot strength is mediated by increased fibrinogen levels in CKD patients.

Keywords: Chronic; Fibrinogen; Hypercoagulability; Kidney failure; TEG.

MeSH terms

  • Adult
  • Blood Coagulation Disorders / diagnosis*
  • Blood Coagulation Tests*
  • Case-Control Studies
  • Colorado
  • Female
  • Humans
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Renal Dialysis
  • Retrospective Studies
  • Thrombelastography