Atherosclerotic and Hemostatic Abnormalities in Patients Undergoing Hemodialysis

Abstract

Vascular events caused by atherosclerosis are the major cause of death in patients undergoing hemodialysis (HD). The relationship between the tests of atherosclerosis and hemostasis in 84 patients with HD was examined. Abnormal test results indicting the occurrence of atherosclerosis were found in 66% by the Fontaine score, in 33% by ankle blood pressures, and in 79% by aortic calcification index (ACI). When HD was prolonged, the mean Fontaine score and ACI were further increased. Particularly, the ACI tended to correlate with HD duration. The ankle-brachial index (ABI) was decreased in patients with HD duration of more than 10 years. Before HD, the plasma levels of fibrinogen, plasmin-plasmin inhibitor complex (PIC), thrombomodulin (TM), and D-dimer were increased, while the plasma levels of protein C (PC), antithrombin (AT), thrombin-antithrombin complex (TAT), and tissue plasminogen activator (tPA)-plasminogen activator inhibitor-I (PAI-I) complex (tPA-PAI-1 complex) were decreased. With prolonged HD, the plasma levels of AT and PC were decreased, while those of D-dimer were increased. The plasma levels of TAT and TPA-PAI-1 complex were significantly increased and those of PIC, soluble fibrin (SF) and D-dimer tended to be high in patients with less than 0.7 of ABI. The plasma levels of D-dimer, TPA-PAI-1 complex, TAT, PIC, and SF tended to be high in patients with more than 0.5 in ABI. These findings suggest that patients undergoing HD have progressive atherosclerosis and that this is associated with some hemostatic abnormalities.

Essentials of anticoagulation in hemodialysis

“…Uremic patients with thrombotic events show significantly higher platelet‐derived microparticle counts than patients without thrombotic events 14 . Antithrombin levels as well as antithrombin activity can be reduced 15,16 . In patients with ESRD, deficiencies of the anticoagulant proteins C and S have been observed 9,15,16 .…”

“…Antithrombin levels as well as antithrombin activity can be reduced 15,16 . In patients with ESRD, deficiencies of the anticoagulant proteins C and S have been observed 9,15,16 . Activated protein C resistance can occur 9 or activity of the anticoagulant protein C can be decreased by inhibitors 9,17 .…”

Aspects of platelet disturbances in haemodialysis patients

“…The risk factors for a hypercoagulable state include enhanced PLT aggregability, increased concentrations of plasma fibrinogen, thrombin–antithrombin complexes (TAT), prothrombin fragment F1 + 2, FVIIIc and von Willebrand Factor (vWF). It is suggested that coagulation aberrations and frequent PLT activation in the case of HD treatment contribute to increased risk of cardiovascular disease [2, 8]. Cardiovascular events related to thrombosis are a predominant cause of death and account for an important morbidity in patients with CKD.…”

Carotid artery intima media thickness as a surrogate marker of atherosclerosis in patient with chronic renal failure on hemodialysis

“…[2] Patients undergoing hemodialysis (HD) have progressive atherosclerosis. [3] Besides the renal disease itself, hemodialysis may also be one of the risk factors for atherosclerosis. [4] The cardiovascular mortality rate is 20–40 times higher for adults on dialysis than for the general population.…”