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Coagulation abnormalities in chronic peritoneal dialysis
1Department of Paediatrics (Nephrology), Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children on chronic peritoneal dialysis exhibit a hypercoagulable state, with altered coagulation and fibrinolytic factors. This may contribute to thrombosis risk, particularly following renal transplantation.
Area of Science:
- Pediatric Nephrology
- Hematology
- Clinical Chemistry
Background:
- Chronic peritoneal dialysis (CPD) is a treatment for pediatric kidney failure.
- The potential for a hypercoagulable state in children on CPD is not well understood.
- Understanding coagulation changes is crucial for managing complications like thrombosis.
Purpose of the Study:
- To investigate the presence of a hypercoagulable state in children undergoing CPD.
- To assess various coagulation and fibrinolytic factor levels in this patient group.
Main Methods:
- Measured coagulation and fibrinolytic factors in 17 children on CPD.
- Compared patient values to established reference ranges.
- Analyzed correlations between dialysis duration and specific factor concentrations.
Main Results:
- Significantly increased activities of factors VII and VIII, and concentrations of von Willebrand factor (vWF), fibrinogen, factor XIIIA, and factor XIIIS were observed.
- Prolonged activated partial thromboplastin time and decreased thrombin clotting time were noted.
- Decreased plasminogen and increased alpha-2-antiplasmin concentrations indicated altered fibrinolysis.
- Low plasma albumin was present in most patients; dialysis duration correlated with vWF and factor VII levels.
- Two patients experienced clinical thrombotic episodes.
Conclusions:
- Children on CPD demonstrate significant coagulation and fibrinolytic abnormalities, suggesting a hypercoagulable state.
- These hemostatic alterations may play a role in the pathogenesis of thrombosis in patients with end-stage renal disease.
- Further research is warranted to explore the clinical implications and management strategies for thrombosis in this population.
Abstract:
To determine whether children treated with chronic peritoneal dialysis have a hypercoagulable state, various coagulation and fibrinolytic factor concentrations or activities were measured in 17 children undergoing chronic peritoneal dialysis. The patients had significantly increased activities of factors VII and VIII, and increased concentrations of von Willebrand factor (vWF), fibrinogen, factor XIIIA and factor XIIIS compared to reference values (P less than 0.001 in each case). The activated partial thromboplastin time was prolonged (P less than 0.001) and the thrombin clotting time was decreased (P less than 0.05) in these children. The prothrombin time and activities of factors XII, XI, IX, X, V and II were not significantly different from control values. Protein C concentrations were similar to normal, but antithrombin III concentrations were increased (P less than 0.05). Within the fibrinolytic pathway, decreased concentrations of plasminogen were found (P less than 0.001) and the concentrations of alpha-2-antiplasmin were increased (P less than 0.001). The plasma albumin concentration was below 33 g/l in 13 of the 17 children. The duration of treatment with peritoneal dialysis was directly correlated with vWF concentrations (P less than 0.001) and inversely correlated with factor VII concentrations (P less than 0.01). Of these patients 2 have since had clinical thrombotic episodes. The coagulation abnormalities found may have a role in the occurrence of thrombosis complicating renal transplantation.