Association of Von Willebrand Factor Level and Activity with GIT Bleeding in Adult Hemodialysis-Dependent ESRD Patients

Gadallah, Abdel-Naser Abdel-Atty; Bahnacy, Abd-allah; Abu Shanab, Ahmed; Saber Rashed, Mostafa Adly; Elkhouly, Aly

doi:10.21608/ejhm.2025.413798.1819

Association of Von Willebrand Factor Level and Activity with GIT Bleeding in Adult Hemodialysis-Dependent ESRD Patients

Document Type : Original Article

Authors

¹ Internal Medicine, Gastroenterology, Hepatology & Endoscopy department, Faculty of Medicine - Menoufia University, Shebin Elkom, Menoufia, Egypt

² Gastroenterology and Hepatology department, Faculty of Medicine, Menoufia University

³ Consultant Hepatologist, University Hospital of Leicester

⁴ Internal Medicine & Hematology, Faculty of Medicine, Mansoura University

⁵ Internal Medicine & Hematology, Faculty of Medicine, Menoufia University

10.21608/ejhm.2025.413798.1819

Abstract

Background: Patients with end-stage kidney disease (ESKD) undergoing hemodialysis, peritoneal dialysis, or kidney transplantation are prone to bleeding complications, partly due to alterations in von Willebrand factor (vWF), a key protein in blood coagulation. Dysfunction or abnormal concentration of vWF may contribute to gastrointestinal (GIT) bleeding.

Aim: This study aimed to evaluate the relationship between vWF levels/activity and GIT bleeding in adult hemodialysis-dependent ESKD patients.

Patients and methods: A case-control study was conducted at Menoufia University Hospital and Mit Ghamr Nephrology and Urology Hospital over four years (Jan 2021–Dec 2024), including 53 end-stage renal disease (ESRD) patients on maintenance hemodialysis and 48 healthy controls.

Results: Among ESRD patients, 7.5% had clinically evident GIT bleeding (three upper & one lower), and 11.3% had positive occult blood tests (two false positives). vWF antigen (vWF-Ag) levels correlated positively with INR (r=0.349, p=0.01) and serum creatinine, and negatively with GFR. vWF ristocetin cofactor activity (vWF:RCo) also correlated positively with INR. Univariate analysis linked lower albumin, higher vWF-Ag, and higher vWF:RCo to increased GIT bleeding risk. In multivariate analysis, vWF:RCo was an independent predictor. Diagnostic performance showed vWF-Ag had 100% sensitivity, 79.3% specificity, PPV of 40% and AUC of 0.948. vWF:RCo had 100% sensitivity, 77.3% specificity, PPV of 28.6% and AUC of 0.841.

Conclusion: vWF dysfunction contributed to GIT bleeding risk in hemodialysis-treated ESRD patients. Both vWF-Ag and vWF:RCo were associated with bleeding, but vWF:RCo independently predicts risk, suggesting its potential as a biomarker for identifying high-risk patients.

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