Lipid-lowering therapy and coagulation/fibrinolysis parameters in patients on peritoneal dialysis.
Patients on continuous ambulatory peritoneal dialysis (CAPD) often have abnormalities of lipid metabolism or coagulation and fibrinolysis, these patients may thus be more susceptible to atherosclerosis than those on hemodialysis. It has been reported that hypercoagulability and hyperfibrinolysis are correlated with abnormalities of lipid metabolism. Therefore, we investigated the effect of a decrease in lipids on the coagulation and fibrinolysis system in CAPD patients with hyperlipidemia who received lipid-lowering therapy. The patients included 5 men and 13 women, with a mean age of 52.5 years. Pravastatin sodium (10 mg/day) and ethyl icosapentate (1800 mg/day) were administered concomitantly for 8 weeks. Lipid levels and coagulation/fibrinolysis parameters were measured before and after therapy. The patients were divided into two groups depending on their response to therapy: responders showed a decrease in total cholesterol or triglycerides by at least 20% and non-responders showed less improvement. In the responders, the levels of protein C, tissue plasminogen activator/plasminogen activator inhibitor-I complex, factor XIII, alpha2-plasmin inhibitor, and D-dimer were significantly lower after therapy than before therapy. Protein C, factor XIII, and alpha2-plasmin inhibitor were also significantly decreased after therapy in non-responders, but the extent of the decrease was smaller. The plasminogen level was significantly increased after therapy in non-responders. These findings suggest that a decrease in lipid levels and/or some other action by lipid-lowering agents may correct abnormalities of coagulation and fibrinolysis in CAPD patients.
The Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan. nyorioka@mcai.med.hiroshima-u.ac.jp
N
N
Yorioka
T
T
Masaki
T
T
Ito
S
S
Kushihata
Y
Y
Nishida
Y
Y
Taniguchi
H
H
Oda
M
M
Yamakido
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001779:Blood Coagulation Factors / Q000502:physiology; D004359:Drug Therapy, Combination; D015118:Eicosapentaenoic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017035:Pravastatin / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D001779:Blood Coagulation Factors; D010975:Platelet Aggregation Inhibitors; C035276:eicosapentaenoic acid ethyl ester; D015118:Eicosapentaenoic Acid; D017035:Pravastatin