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Lipid-lowering therapy and coagulation/fibrinolysis parameters in patients on peritoneal dialysis
1The Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan. nyorioka@mcai.med.hiroshima-u.ac.jp
Insights
Lipid-lowering therapy in continuous ambulatory peritoneal dialysis (CAPD) patients with hyperlipidemia improved coagulation and fibrinolysis. This suggests that managing lipid levels may help correct these blood clotting abnormalities in CAPD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Hematology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) patients often exhibit lipid metabolism and coagulation/fibrinolysis abnormalities.
- These abnormalities may increase atherosclerosis risk compared to hemodialysis.
- Hypercoagulability and hyperfibrinolysis are linked to lipid metabolism disorders.
Purpose of the Study:
- To investigate the impact of lipid reduction on coagulation and fibrinolysis systems in hyperlipidemic CAPD patients.
- To assess the effects of combined pravastatin sodium and ethyl icosapentate therapy.
Main Methods:
- 18 hyperlipidemic CAPD patients (5 men, 13 women; mean age 52.5 years) received 8 weeks of pravastatin sodium (10 mg/day) and ethyl icosapentate (1800 mg/day).
- Lipid levels and coagulation/fibrinolysis parameters were measured pre- and post-therapy.
- Patients were categorized into responders (≥20% decrease in total cholesterol or triglycerides) and non-responders.
Main Results:
- Responders showed significant reductions in protein C, tissue plasminogen activator/plasminogen activator inhibitor-I complex, factor XIII, alpha2-plasmin inhibitor, and D-dimer.
- Non-responders also had decreased protein C, factor XIII, and alpha2-plasmin inhibitor, but to a lesser extent.
- Plasminogen levels increased significantly in non-responders post-therapy.
Conclusions:
- Lipid-lowering therapy can ameliorate coagulation and fibrinolysis abnormalities in CAPD patients with hyperlipidemia.
- The observed improvements suggest that managing lipid levels, or potentially other actions of the lipid-lowering agents, plays a role in correcting these hemostatic derangements.
Abstract:
Patients on continuous ambulatory peritoneal dialysis (CAPD) often have abnormalities of lipid metabolism or coagulation and fibrinolysis, these patients may thus be more susceptible to atherosclerosis than those on hemodialysis. It has been reported that hypercoagulability and hyperfibrinolysis are correlated with abnormalities of lipid metabolism. Therefore, we investigated the effect of a decrease in lipids on the coagulation and fibrinolysis system in CAPD patients with hyperlipidemia who received lipid-lowering therapy. The patients included 5 men and 13 women, with a mean age of 52.5 years. Pravastatin sodium (10 mg/day) and ethyl icosapentate (1800 mg/day) were administered concomitantly for 8 weeks. Lipid levels and coagulation/fibrinolysis parameters were measured before and after therapy. The patients were divided into two groups depending on their response to therapy: responders showed a decrease in total cholesterol or triglycerides by at least 20% and non-responders showed less improvement. In the responders, the levels of protein C, tissue plasminogen activator/plasminogen activator inhibitor-I complex, factor XIII, alpha2-plasmin inhibitor, and D-dimer were significantly lower after therapy than before therapy. Protein C, factor XIII, and alpha2-plasmin inhibitor were also significantly decreased after therapy in non-responders, but the extent of the decrease was smaller. The plasminogen level was significantly increased after therapy in non-responders. These findings suggest that a decrease in lipid levels and/or some other action by lipid-lowering agents may correct abnormalities of coagulation and fibrinolysis in CAPD patients.