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Reduced blood levels of coagulation inhibitors in chronic hemodialysis compared with CAPD
S V Bertoli1, G B di Belgiojoso, M Trezzi
1Nephrology Department, Sacco Hospital, Milan, Italy.
Insights
Hemodialysis (HD) patients exhibit reduced coagulation inhibitors compared to continuous ambulatory peritoneal dialysis (CAPD) patients, potentially increasing thrombotic risk. Erythropoietin (EPO) treatment in HD patients may contribute to this prothrombotic state.
Area of Science:
- Nephrology
- Hematology
- Clinical Chemistry
Background:
- Uremic patients undergoing dialysis face altered coagulation profiles.
- Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) represent distinct renal replacement therapies.
- Understanding coagulation inhibitor levels is crucial for assessing thrombotic risk in these patient populations.
Purpose of the Study:
- To quantify and compare coagulation inhibitors between HD and CAPD uremic patients.
- To evaluate differences in anticoagulant activity and their clinical implications.
- To investigate potential factors, including erythropoietin (EPO) use, contributing to altered coagulation.
Main Methods:
- Study included 20 HD and 20 CAPD patients.
- Measured parameters included Protein C (PC), Protein S (PS), Antithrombin III (AT III), prothrombin activation fragment (F1+2), and clotting times (PT, PTT).
- Analyses were performed between dialysis exchanges.
Main Results:
- HD patients showed reduced levels of PC, PS, and AT III compared to CAPD patients.
- Prothrombin activation fragment (F1+2) levels were significantly higher in HD patients (p < 0.05).
- Protein S (PS) functional activity was inversely correlated with dialysis duration and potentially affected by erythropoietin (EPO) treatment.
Conclusions:
- Hemodialysis is associated with a reduction in key coagulation inhibitors compared to CAPD.
- This reduction may explain the higher thrombotic risk observed in HD patients.
- Erythropoietin (EPO) therapy in HD patients could be a contributing factor to the observed prothrombotic state via reduced PS activity.
Abstract:
The aim of this study was to measure the coagulation inhibitors in two groups of uremic patients treated with hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) to evaluate the differences in anticoagulant activity. In 20 patients on HD and 20 on CAPD, mean age 66 +/- 8 and 58 +/- 14 years, respectively, the following parameters were determined between dialysis exchanges: protein C (PC), protein S (PS), antithrombin III (AT III), electrophoresis, prothrombin activation fragment (F1+2), alpha 1 antitripsin (alpha 1 AT), prothrombin time (PT), and activated partial thromboplastin time (PTT). The mean values of PC, PS, and AT III were respectively, 95.7 +/- 16 on HD and 92 +/- 23 on CAPD; 82.2 +/- 13.6 on HD and 90.5 +/- 13.6 on CAPD; the mean value F1+2 was 1.2 +/- 0.5 on HD and 1.04 +/- 0.5 on CAPD (p < 0.05). A good correlation between PS and AT III% functional activity (p < 0.03, r = 0.5) in both groups was found. More-over, PS functional activity was inversely correlated with duration of dialysis (p < 0.05, r = -0.3). HD patients showed a reduction of coagulation inhibitors compared with CAPD patients. Such a phenomenon could justify the increased thrombotic risk in HD patients. Since 80% of those on HD and only 20% of those on CAPD received erythropoietin (EPO), the prothrombotic state in HD could be due to reduced PS activity secondary to EPO treatment.