Impact of Dialysis Modality on Coagulation and Platelet Function

Study Overview
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Brief Summary
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The investigators will evaluate the impact of dialysis modality (intermittent hemodialysis or continuous renal replacement therapy) in coagulation and platelet function in critically ill patients

Detailed Description
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An prospective observational study will be conducted to confirm the impact of two dialysis modalitites on coagulation and platelet function in critically ill patients requiring renal replacement therapy using laboratory test, Multiplate and ROTEM.

Official Title
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Impact of Dialysis Modality on Coagulation and Platelet Function in Critically Ill Patients: Intermittent Hemodialysis vs. Continuous Renal Replacement Therapy

Conditions
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Renal Replacement Therapy

Intervention / Treatment
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* Procedure: dialysis mode


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Critically ill adult patients in surgical intensive care unit who require renal replacement therapy Exclusion Criteria: Patients treated with anti-coagulation therapy due to thrombosis/embolism Patients who take anti-platelet drug due to cardiac or cerebrovascular diseased Patients treated with pharmacological prophylaxis of deep vein thrombosis Patients who received blood products within 24 hours of dialysis initiation Patients who do not want life-sustaining care including renal replacement therapy

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Intermittent hemodialysis<br>patients who are going to undergo intermittent hemodialysis or patients who are going to switch dialysis mode to intermittent hemodialysis from continuous renal replacement therapy Laboratory test including complete blood count, prothrombin time, activated partial thromboplastin time, protein C, protein S and D-dimer, EXTEM of ROTEM and Multiplate® platelet function analysis will be checked just before dialysis initiation and immediately after dialysis termination | Procedure: dialysis mode<br>* intermittent hemodialysis or continuous renal replacement therapy<br>|
| continuous renal replacement therapy<br>patients who are going to undergo continuous renal replacement therapy Laboratory test including complete blood count, prothrombin time, activated partial thromboplastin time, protein C, protein S and D-dimer, EXTEM of ROTEM and Multiplate platelet function analysis will be checked within 24 hours after dialysis initiation and 48 hours after taking first blood sample | Procedure: dialysis mode<br>* intermittent hemodialysis or continuous renal replacement therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| clotting time (CT) in EXTEM in rotational thromboelastometry (ROTEM) | the difference of changes in CT in EXTEM of ROTEM (seconds) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Multiplate® platelet function analysis area under curve unit | the difference of platelet function using Multiplate® | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| clot formation time (CFT) in EXTEM | the difference of CFT in EXTEM using ROTEM (seconds) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| Amplitude 10 minutes after CT (A10) in EXTEM | the difference of A10 in EXTEM using ROTEM (mm) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| α-angle in EXTEM | the difference of α-angle in EXTEM using ROTEM (º) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| Maximal clot firmness (MCF) in EXTEM | the difference of MCF in EXTEM using ROTEM (mm) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| prothrombin time | the difference of prothrombin time (seconds) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| activated partial thromboplastin time | the difference of activated partial thromboplastin time (seconds) | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| Protein C | the difference of Protein C | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| Protein S | the difference of Protein S | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| fibrinogen | the difference of fibrinogen | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| D-dimer | the difference of D-dimer | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| platelet count | the difference of platelet count | before and after applying each mode of dialysis (4 hours in intermittent hemodialysis and 48 hours in continuous renal replacement therapy | 
| the amount of blood transfusion | the amount of blood transfusion for 24 hours after taking second blood sample | 24 hours | 
| hemodynamic changes | changes of mean arterial pressure > 20 %, increased vasopressor/inotropics | 24 hours | 
| changes of characteristics or amount of drainage | changes of characteristics or amount of drainage | 24 hours |