COVID-19 increases extracorporeal coagulation during hemodialysis associated with upregulation of vWF/FBLN5 signaling in patients with severe/critical symptoms

• Published in: BMC infectious diseases 2024-04, Vol.24 (1), p.427-427, Article 427
• Main Authors: Yang, Guang, Shan, Hui, Wu, Dibin, Li, Sanmu, Lai, Zhiwei, Zheng, Fengping, Xiong, Zibo, Xiong, Zuying, Diao, Yuhan, Shan, Ying, Chen, Yun, Wang, Aihong, Liang, Wei, Yin, Yuxin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulant; Anticoagulants; Anticoagulants (Medicine); Blood clots; Blood Coagulation; Care and treatment; Cascade chemical reactions; Chronic kidney failure; Coagulation; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - metabolism; Dosage and administration; Enzyme-linked immunosorbent assay; Ethylenediaminetetraacetic acid; Failure; Female; Health aspects; Hemodialysis; Hemodialysis patients; Hospitals; Humans; Infection; Infections; Inflammation; Kidney diseases; Male; Middle Aged; New coronavirus-19; Nitrogen dioxide; Oxidative stress; Pathogens; Patient safety; Peritoneal dialysis; Potassium; Prevention; Protein composition; Proteins; Proteomics; Renal Dialysis - adverse effects; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Risk; Risk factors; SARS-CoV-2; Signal Transduction; Signs and symptoms; Spectrometry; Subgroups; Thromboembolism; Thrombosis; Up-Regulation; Venous access; Viral diseases; Vital signs; von Willebrand Factor - analysis; von Willebrand Factor - metabolism
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09245-9

COVID-19 has been shown to increase the risk of extracorporeal coagulation during hemodialysis in patients, but the underlying mechanism remains unclear. This study aimed to investigate the effect and mechanism of COVID-19 on the risk of extracorporeal coagulation in patients with chronic kidney disease undergoing hemodialysis. A retrospective analysis of the extracorporeal coagulation status of 339 hemodialysis patients at our center before and after COVID-19 infection was performed, including subgroup analyses. Post-infection blood composition was analyzed by protein spectrometry and ELISA. Compared to the pre-COVID-19 infection period, COVID-19-induced extracorporeal coagulation predominantly occurred in patients with severe/critical symptoms. Further proteomic analysis demonstrated that in patients with severe/critical symptoms, the coagulation cascade reaction, platelet activation, inflammation, and oxidative stress-related pathways were significantly amplified compared to those in patients with no/mild symptoms. Notably, the vWF/FBLN5 pathway, which is associated with inflammation, vascular injury, and coagulation, was significantly upregulated. Patients with severe/critical COVID-19 symptoms are at a higher risk of extracorporeal coagulation during hemodialysis, which is associated with the upregulation of the vWF/FBLN5 signaling pathway. These findings highlight the importance of early anticoagulant therapy initiation in COVID-19 patients with severe/critical symptoms, particularly those undergoing hemodialysis. Additionally, vWF/FBLN5 upregulation may be a novel mechanism for virus-associated thrombosis/coagulation.