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Risk factors of ischemic cardiac disease in patients on continuous ambulatory peritoneal dialysis
R Cavagna1, R Schiavon, C Tessarin
1Nephrology and Dialysis Unit, City Hospital of Belluno, Italy.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) patients show increased blood clotting factors and reduced clot breakdown. This suggests a higher risk of atherothrombotic cardiovascular disease in CAPD patients.
Area of Science:
- Cardiovascular Science
- Nephrology
- Hematology
Background:
- Elevated fibrinogen, factor VII coagulant activity (F VIIc), and plasminogen activator inhibitor (PAI-1) are linked to thrombotic events and atherothrombotic cardiovascular disease.
- These coagulation factors are crucial in the development of blood clots and cardiovascular disease progression.
Purpose of the Study:
- To evaluate plasma levels of fibrinogen, F VIIc, PAI-1, tissue plasminogen activator (t-PA), basal insulin, and lipid profiles in continuous ambulatory peritoneal dialysis (CAPD) patients.
- To compare these parameters in CAPD patients with hemodialysis (HD) patients and healthy subjects.
Main Methods:
- Plasma levels of fibrinogen, F VIIc, PAI-1, t-PA, insulin, and lipids were measured.
- Patients included 15 CAPD patients, 33 HD patients, and 59 healthy controls.
Main Results:
- CAPD patients exhibited significantly increased total cholesterol and triglycerides compared to controls, with no difference in HDL cholesterol.
- Fibrinogen and F VIIc were significantly higher in both CAPD and HD groups versus controls.
- PAI-1 and t-PA levels were elevated in CAPD patients, potentially due to endothelial cell activation from dialysis solutions.
Conclusions:
- CAPD patients display a hypercoagulable and hypofibrinolytic state, indicated by elevated fibrinogen, F VIIc, PAI-1, and t-PA.
- This prothrombotic condition in CAPD patients may increase their risk of atherothrombotic cardiovascular events.
Abstract:
Elevated plasma levels of fibrinogen, factor VII coagulant activity (F VIIc), and plasminogen activator inhibitor (PAI-1) have been reported to be strictly associated with thrombotic events and are considered to be important risk markers of atherothrombotic cardiovascular disease. Therefore, we evaluated in 15 patients on continuous ambulatory peritoneal dialysis (CAPD) the plasma levels of these coagulation factors, basal insulin values, and the lipid pattern in comparison with 33 hemodialysis (HD) patients and 59 healthy subjects. In CAPD the total cholesterol and triglyceride results were significantly increased, but no difference was found in HDL cholesterol. Fibrinogen and F VIIc results were significantly higher in CAPD and HD than in the control group, probably due to an increased hepatic synthesis as a nonspecific response to the peritoneal protein loss. Elevated F VIIc activity may be caused by the presence of large negatively charged lipoproteins, in vivo thrombin formation, or reduced hepatic clearance. Both PAI 1 and t-PA results were higher in CAPD, probably due to an increased synthesis by endothelial cells activated by glucose peritoneal absorption and hypertonic dialysis solutions. The contemporary elevation of fibrinogen, F VIIc, PAI-1, and t-PA suggests that CAPD patients present a hypercoagulability and hypofibrinolysis condition, which may promote the development of atherothrombotic events.