title: The effects of recombinant human erythropoietin on hemostasis and fibrinolysis in hemodialysis patients.
abstract: Thromboembolism might complicate the treatment of patients with chronic renal failure with Recombinant Human Erythropoietin (ReHuEPO). In order to detect prothrombotic changes, a number of hemostatic and fibrinolytic parameters was determined during ReHuEPO treatment of fifteen chronic hemodialysis patients (mean age 47.1 years; ten females, five males). To avoid the influence of hemoconcentration and/or dilution, the patients were kept normovolemic, using the method of echography of the inferior vena cava diameter. In a first group of eight patients, we investigated platelet count and function. During ReHuEPO, a significant rise of hematocrit (19 +/- 3 to 34 +/- 5%, p < 0.001) was observed. Bleeding time shortened (7'33'' +/- 3'39'' to 3'41'' +/- 3'19''; p < 0.001) and platelet count increased (222 +/- 45 to 254 +/- 49 10 9/l; p < 0.005). The initial negative in vitro spontaneous platelet reactivity became positive in two of them, whereas the decrease in ADP threshold in the whole group (2.0 +/- 0.1 to 1.10 +/- 0.4 mumol, p < 0.02) indicated an increased induced platelet reactivity. In all patients prothrombotic changes were observed. The protein-C antigen and protein-C activity and the total and free protein-S antigen decreased significantly. The plasminogen activator inhibitor (PAI) activity in the whole group did not change significantly (6.4 +/- 4.1 to 5.4 +/- 4.8 AU/ml). However, in the patients with fistula thrombosis (n = 3), higher values in all test points were found compared to those without thrombosis.
authors.affiliation: Department of Nephrology, University Hospital Maastricht, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wirtz
authors.forename: J W
authors.initials: JW
authors.lastname: van Esser
authors.forename: K
authors.initials: K
authors.lastname: Hamulyák
authors.forename: K M
authors.initials: KM
authors.lastname: Leunissen
authors.forename: J P
authors.initials: JP
authors.lastname: van Hooff
mesh_terms: D004921:Erythropoietin / Q000009:adverse effects*; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006400:Hematocrit; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000378:metabolism; D006435:Renal Dialysis; D013923:Thromboembolism / Q000139:chemically induced
chemical_list: D011486:Protein C; D004921:Erythropoietin