Coagulation abnormalities in diabetic patients undergoing renal transplantation.
Nineteen diabetic (DM) and twenty-two non-diabetic (NDM) uraemic patients undergoing renal transplantation were studied to evaluate coagulation abnormalities. Thirty-three healthy patients admitted for minor surgery served as controls. Antithrombin III (AT III), thromboelastogram (TEG), other haemostatic parameters and the influence of dialysis treatment were assessed in DM and NDM uraemic patients. All uraemic patients were anaemic and bleeding time was slightly prolonged (NS). The level of AT III was raised in the DM group when compared in the healthy controls (P < 0.001). Prothrombin time (PT) percentage was increased in both uraemic groups (P < 0.001) in comparison with the controls. Thrombocytosis was marked in DM patients (P < 0.001) when compared with controls and NDM patients. TEG parameters were similar in all groups. Continuous peritoneal dialysis treatment (CAPD) was associated with elevated total platelet count in NDM (P < 0.05) and DM group (P < 0.05) when compared with haemodialysis (HD) patients. Also, the PT was shortened in DM patients on CAPD vs HD (P < 0.05). AT III level was elevated in NDM patients on CAPD compared with those on HD (P < 0.05). There was no difference in clinical bleeding tendency during renal transplantation. Postoperatively, one patient in NDM group suffered from thrombosis of the graft artery and transplantectomy had to be performed. Our study showed a prethrombotic state in diabetic uraemic patients admitted for renal transplantation. The increased AT III activity may protect these patients against thrombotic complications. The role of CAPD treatment requires further studies.
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
E
E
Reissell
M
M
Lalla
K
K
Höckerstedt
L
L
Lindgren
D000328:Adult; D000990:Antithrombin III / Q000032:analysis; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology; D001780:Blood Coagulation Tests; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003928:Diabetic Nephropathies / Q000097:blood* / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D014511:Uremia / Q000097:blood* / Q000601:surgery* / Q000628:therapy
D000990:Antithrombin III