The influence of the haemodialysis procedure on platelets, coagulation and fibrinolysis.
In end-stage renal disease, in particularly when treated with haemodialysis, the function of platelets, coagulation and fibrinolytic systems can be disturbed, thus contributing to either thrombotic or bleeding complications. It is important to know whether the currently used haemodialysis procedure itself (by biocompatible membranes and better anticoagulation with nandroparin) affects platelets, coagulation or fibrinolysis. In 15 patients who had been treated with chronic haemodialysis, we measured and compared platelet aggregation (induced by adenosine diphosphate, collagen and epinephrine), the markers of coagulation and fibrinolysis activation (thrombin-antithrombin complexes, thrombin fragments F1+2, D-dimer), and fibrinolytic parameters, i.e. fibrinogen, plasminogen, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 antigen and activity, before and immediately after the regular haemodialysis sessions. We did not find differences between pre- and post-haemodialysis platelet aggregation induced with all agents. Markers of coagulation and fibrinolysis activation remained unchanged during the process of haemodialysis. However, in post-haemodialysis samples, t-PA activity was significantly increased. Other fibrinolytic parameters remained unchanged. In conclusion, our results showed that the current technique of haemodialysis procedure does not affect platelet aggregation or activate coagulation, and therefore, does not contribute to a thrombotic tendency. However, it does directly affect fibrinolysis through activation of t-PA, which might be clinically relevant since this could increase the bleeding tendency in some haemodialysis patients.
Sabovic
Miso
M
Department of Vascular Diseases, University Clinical Centre, Ljubljana, Slovenia. miso.sabovic@trnovo.kclj.si
Salobir
Barbara
B
Preloznik Zupan
Irena
I
Bratina
Petra
P
Bojec
Vida
V
Buturovic Ponikvar
Jadranka
J
D000368:Aged; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000503:physiopathology; D001792:Blood Platelets / Q000502:physiology*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation; D006435:Renal Dialysis; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology