Coagulation abnormalities as predictors of renal dysfunction in heart failure with reduced ejection fraction

Introduction: Heart failure (HF) is a prothrombotic state that is also associated with the progression of renal dysfunction. However, it is unknown whether coagulation abnormalities are associated with progressive cardiorenal syndrome.Aim of the research: To evaluate activators and inhibitors of coagulation and fibrinolysis and their relationship with renal failure in HF patients.Material and methods: Coagulation biomarkers such as thrombin-antithrombin III, human tissue-type plasminogen ac-tivator, human plasminogen activator inhibitor, von Willebrand factor (vWF), soluble thrombomodulin (sTM), human pro -thrombin fragments (F1+F2), and protein C were evaluated in 36 consecutive HF patients without anticoagulation and in 19 controls matched in age and gender.Results: HF patients, compared to controls, had lower levels of C protein (p = 0.04) and F1 + F2 (p < 0.001) but higher levels of vWF (p < 0.001) and borderline sTM (p = 0.07). Similarly, haemoglobin (p < 0.001) and glomerular filtration rate (GFR) (p = 0.004) were lower in HF, while INR (p < 0.001), NT-proBNP (p < 0.001), and asymmetric dimethylarginine (ADMA) (p < 0.001) were higher. Most of the echocardiographic parameters differed between the 2 groups. From coagulation bio-markers, sTM (r = -0.66; p < 0.001) and vWF (r = -0.41; p = 0.002) were associated with eGFR. Most of the echocardiographic and laboratory parameters were also related to eGFR. After classifying all variables into 5 categories; laboratory tests, echo -cardiographic parameters, vascular reactivity, haemodynamics, and coagulation parameters, multivariable linear regression showed that coagulation parameters were the most strongly associated with eGFR (r2 = 0.48, p < 0.001).Conclusions: In the study population, coagulation disorders were most strongly associated with impaired renal function, independently of other parameters.