Fibrinolytic activity during hemodialysis: a biocompatibility-related phenomenon

According to recent reports, fibrinolytic activity may be enhanced during hemodialysis. The aim of this work was to study the fibrinolytic activity in uremic patients, and to evaluate the effect of membrane biocompatibility on the fibrinolytic system during hemodialysis. Tissue plasminogen activator (t-PA), t-PA antigen, plasminogen activator-inhibitor (PAI), plasminogen (PL) and alpha-2-antiplasmin (AP) were measured in 10 uremic patients on maintenance hemodialysis treated sequentially with Cuprophane and polyacrylonitrile (AN69) membranes. Blood samples were obtained before and at 15, 60 and 120 minutes after the initiation of dialysis. Blood was also collected from 20 healthy individuals who served as controls. During cuprophane dialysis, t-PA increased significantly at 60 minutes (14.8 vs. 8.4 IU/ml, P < 0.05) and at 120 minutes (13.8 P < 0.01). This was accompanied by an increase in t-PA antigen, which was significant at 15 (5.1 vs. 13.1 ng/ml), 60 (15.2) and 120 (9.6) minutes (P < 0.05) of dialysis. However, during AN69 dialysis t-PA and t-PA antigen plasma levels remained stable. No significant changes were observed in PL, AP or PAI during hemodialysis with either membrane. In conclusion, hemodialysis enhances fibrinolytic activity, which is likely the result of t-PA Ag release. Therefore, this phenomenon seems to be closely related to dialysis membrane biocompatibility.