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Intraperitoneal hypercoagulation and hypofibrinolysis is present in childhood peritonitis
A W de Boer1, M Levi, R E Reddingius
1Department of Pediatrics, University Hospital Nijmegen, The Netherlands.
Insights
Peritonitis during peritoneal dialysis is linked to catheter obstruction due to hypercoagulability and hypofibrinolysis. Studies show increased thrombin-antithrombin III complexes and plasminogen activator inhibitor type 1 during peritonitis.
Area of Science:
- Nephrology
- Hematology
- Pediatrics
Background:
- Peritoneal dialysis (PD) is a common treatment for kidney failure.
- Catheter obstruction is a frequent complication of PD, particularly during peritonitis.
- Hypercoagulability and hypofibrinolysis are suspected mechanisms for increased obstruction.
Purpose of the Study:
- To investigate the hemostatic balance during peritonitis in children undergoing PD.
- To compare markers of coagulation and fibrinolysis in children with and without peritonitis.
Main Methods:
- Studied 7 children with peritonitis (group A) and 12 children in stable PD (group B).
- Measured plasma levels of thrombin-antithrombin III complexes (TAT), plasminogen activator inhibitor type 1 antigen (PAI-1), tissue-type plasminogen activator antigen (t-PA), D-dimer (DD), and plasmin-alpha2-antiplasmin complexes (PAP).
- Assessed transperitoneal protein transport using albumin, beta2-microglobulin, IgG, and alpha2-macroglobulin.
Main Results:
- During peritonitis, TAT and PAI-1 were significantly higher, while PAP and DD were significantly lower compared to stable PD.
- t-PA levels were similar between groups.
- All measured hemostatic markers were elevated compared to baseline, suggesting intraperitoneal production.
Conclusions:
- Peritonitis in children undergoing PD is associated with hypercoagulability and hypofibrinolysis.
- These hemostatic changes may contribute to the increased rate of peritoneal catheter obstruction during peritonitis.
Abstract:
An increased rate of obstruction of peritoneal dialysis catheters is observed during peritonitis. Hypercoagulation and hypofibrinolysis may explain this increased occurrence. We studied plasminogen activator inhibitor type 1 antigen (PAI-1), tissue-type plasminogen activator antigen (t-PA), D-dimer (DD), plasmin-alpha2-antiplasmin complexes (PAP), and thrombin-antithrombin III complexes (TAT) in 7 children with peritonitis (group A) and 12 children during stable peritoneal dialysis (group B). Albumin, beta2-microglobulin, IgG, and alpha2-macroglobulin were measured for baseline transperitoneal protein transport. After a dwell of 6 h with 1.36% Dianeal, dialysate and serum samples were collected. Dialysate to plasma ratios of all proteins were calculated. During peritonitis (group A) TAT was higher: 34.7 versus 22.0 (P=0.01). PAI-1 was increased in group A: 76.5 versus 22.9 (P=0.004). PAP was decreased during peritonitis (group A): 24.9 versus 39.3 (P=0.01). In group A, DD were decreased. 10.8 versus 26.7 (P=0.002). t-PA was similar in both groups (23.7 in group A vs. 27.7 in group B; P=0.26). In both groups TAT, PAI-1, t-PA, PAP, and DD were significantly higher than in baseline transperitoneal transport, suggesting intraperitoneal production. Hypercoagulability and hypofibrinolysis were present during peritonitis compared with the control situation.