Fibrinogen and fibrinolytic activity in CAPD patients with atherosclerosis and its correlation with serum albumin.
OBJECTIVE
It has been suggested that hypoalbuminemia in dialysis patients leads to a hypercoagulable state, however, the relationship between serum albumin and fibrinogen or fibrinolytic activity has not been well-documented. The aim of this study was to investigate the changes of fibrinogen, tissue plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), and lipid levels in continuous ambulatory peritoneal dialysis (CAPD) patients with atherosclerosis, and the relationship between those factors and serum albumin.


METHODS
A cross-sectional study.


METHODS
A university hospital.


METHODS
Twenty CAPD patients with atherosclerosis, 49 CAPD patients without atherosclerosis, and 33 normal controls were included. Presence of atherosclerosis was determined by positive results in a stress thallium single-photon emission computed tomography or an ankle brachial index less than 0.9. Coronary angiography and/or Doppler ultrasound of extremities were followed for the patients with positive results to confirm atherosclerotic cardiovascular disease.


METHODS
tPA and PAI-1 levels were determined with ELISA method, and fibrinogen with thrombin time method. Serum albumin and lipids were also measured.


RESULTS
Serum albumin and HDL-cholesterol levels were significantly lower, and the ratio of total cholesterol/HDL was significantly higher, in CAPD patients than in normal controls. CAPD patients with atherosclerosis had significantly higher fibrinogen, tPA, and PAI-1 levels than other groups: tPA was an independent predictor of atherosclerotic vascular disease in CAPD patients in stepwise logistic regression analysis. Serum albumin level was inversely correlated with fibrinogen (r = -0.28; p < 0.05) in CAPD patients, but not with tPA or PAI-1 levels. PAI-1 level was correlated with tPA (r = 0.37; p < 0.01) and triglycerides (r = 0.32; p < 0.05).


CONCLUSIONS
Association of high levels of fibrinogen and PAI-1 with lipid disorders may be of importance in the development of atherosclerosis in CAPD patients. Hypoalbuminemia may contribute to atherosclerosis via increased synthesis of fibrinogen.
Kim
K J
KJ
Asan Medical Center, Seoul, Korea.
Yang
W S
WS
Kim
S B
SB
Lee
S K
SK
Park
J S
JS
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D012016:Reference Values; D012709:Serum Albumin / Q000378:metabolism*; D010959:Tissue Plasminogen Activator / Q000097:blood
D017395:Plasminogen Activator Inhibitor 1; D012709:Serum Albumin; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator