Characterization of the pro-thrombotic state in CAPD patients.
OBJECTIVE
To investigate whether a chronic pro-thrombotic tendency, which may contribute to a high rate of atherothrombotic disease, is present in patients treated for continuous peritoneal dialysis (CAPD), and, if so, what its pattern is. We investigated this issue by jointly exploring all the systems involved, the coagulation and fibrinolytic systems and platelets.


METHODS
Markers of coagulation activation, markers of fibrinolysis activation, and standard fibrinolytic parameters and platelet aggregation induced by different agents were measured in 15 patients treated by CAPD and in 15 matched, healthy controls. All CAPD patients received erythropoietin, were in the stable condition, and did not have acute disease or malignancy.


RESULTS
CAPD patients had substantially (p < 0.001) increased levels of prothrombin fragments F1+2, disclosing a low-grade activation of the coagulation system. D-dimer was also significantly (p < 0.05) increased, whereas the levels of t-PA antigen and activity, PAI antigen and activity, and plasminogen were comparable to controls, suggesting that slight secondary (and not primary) activation of fibrinolysis due to coagulation activation took place. Patients had significantly (p < 0.05) elevated levels of fibrinogen. A study of platelet aggregation (induced by adenosine diphosphate, collagen, and epinephrine) did not show platelet hyperactivity in patients.


CONCLUSIONS
We found that a pro-thrombotic tendency is present in the plasma of CAPD patients. The main reason for a pro-thrombotic state is chronic low-grade activation of the coagulation system and elevated levels of fibrinogen. The fibrinolytic system and platelets seemingly do not contribute to this pro-thrombotic tendency.
Preloznik Zupan
Irena
I
Department of Hematology, University Medical Centre, Ljubljana, Slovenia. irena.zupan@kclj.si
Sabovic
Miso
M
Salobir
Barbara
B
Buturovic Ponikvar
Jadranka
J
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology; D016022:Case-Control Studies; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods*; D010974:Platelet Aggregation / Q000502:physiology*; D010976:Platelet Count; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013927:Thrombosis / Q000209:etiology* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000097:blood
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D010959:Tissue Plasminogen Activator