Some aspects of hemostasis in CAPD patients treated with erythropoietin.
BACKGROUND
Bleeding diathesis and simultaneous thrombotic complications may be seen in dialyzed patients. Erythropoietin may shift the precarious balance of the hemostatic system towards thrombosis. Thrombin activatable fibrinolysis inhibitor (TAFI) is a key protein linking coagulation and fibrinolysis.


METHODS
The effects of 3-month erythropoietin treatment on some hemostatic parameters--TAFI, fibrinolytic activity index (FAI), markers of ongoing coagulation (thrombin-antithrombin complexes and prothrombin fragments 1 + 2), marker of ongoing fibrinolysis (plasmin-antiplasmin complexes) and marker of endothelial cell injury (thrombomodulin)--were studied in 17 patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD not treated with rHuEPO were also studied. Healthy volunteers served as a control group. 2,000 U erythropoietin was given subcutaneously three times a week. Commercially available kits were used to determine hemostatic parameters.


RESULTS
All the hemostatic parameters studied were significantly higher in CAPD patients when compared to the control group. All these hemostatic parameters except the plasmin-antiplasmin complexes did not differ significantly between patients before rHuEPO therapy and patients without rHuEPO. Erythropoietin therapy resulted in a significant decrease in plasmin-antiplasmin complexes, a significant rise in FAI after 3 months of drug administration, and a tendency to decrease the TAFI concentration and activity (after 1 month, p = 0.11 and p = 0.10, respectively; after 3 months p = 0.07 and p = 0.06, respectively). Treatment with erythropoietin did not affect platelet count, prothrombin time, activated partial thromboplastin time, cholesterol, triglycerides, fibrinogen, total protein, albumin, serum iron, ferritin, fibronectin, pH, bicarbonates, creatinine, and urea. Hemoglobin and hematocrit increased significantly after 1 month of the therapy.


CONCLUSIONS
Short-term treatment with erythropoietin seems to minimally affect hemostasis in CAPD patients.
Małyszko
Jolanta
J
Department of Nephrology and Internal Medicine, Medical Academy of Białystok, Zurawia 14, PL-15-540 Białystok, Poland. jolmal@poczta.onet.pl
Suchowierska
Ewa
E
Małyszko
Jacek S
JS
Myśliwiec
Michał
M
D000328:Adult; D015415:Biomarkers; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D015992:Body Mass Index; D004906:Erythrocyte Count; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005341:Fibrinolysin / Q000096:biosynthesis; D005342:Fibrinolysis; D006400:Hematocrit; D006487:Hemostasis / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D011994:Recombinant Proteins; D018180:Thrombomodulin / Q000378:metabolism
D015415:Biomarkers; D011994:Recombinant Proteins; D018180:Thrombomodulin; D004921:Erythropoietin; D005341:Fibrinolysin