Coagulation, fibrinolysis and fibrinolysis inhibitors in haemodialysis patients: contribution of arteriovenous fistula

Erdem, Yunus; Haznedaroğlu, İbrahim C.; Celik, I.B.; Yalcin, A. U.; Yasavul, Ünal; Turgan, Çetin; Çağlar, Şali

doi:10.1093/ndt/11.7.1299

Cited by 25 publications

(16 citation statements)

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“…[3][4][5] This is due to increased plasma concentrations of fibrinogen, PAI-1, PAI-1 to tPA ratio, and the activity of coagulation factor VII, and decreased plasma tPA concentration and the activity of protein C. [4][5][6][7][8][9][10][11][12][13][14] Hypercoagulability is a major cause of complications in hemodialysis patients, leading not only to possibly fatal complications such as ischemic heart disease or stroke, but also to thrombus formation in arteriovenous fistulas. [3][4][5]15 In our study, L-carnitine supplement cause a 98 mg/dL decrease in plasma fibrinogen concentration and this reduction was significant as compared to the placebo group. We found no research in available literature about the effect of L-carnitine supplement on plasma fibrinogen concentration to be compared with the results of our study.…”

Section: Discussionsupporting

confidence: 54%

“…[4][5][6][7][8][9][10][11][12][13][14] Hypercoagulability is an important risk factor for thrombosis and its complications such as ischemic heart disease, stroke, and vascular access failure in hemodialysis patients and contributes substantially to high mortality in this population. [3][4][5]15 L-Carnitine has largely been studied and is also frequently used in hemodialysis patients, but according to the available literature, no study investigated the effects of L-carnitine supplement on plasma coagulation (including fibrinogen, coagulation factors V, VII, IX, and PAI-1) and anticoagulation (such as protein C and tPA) factors in hemodialysis patients. Only one study in patients with peripheral vascular diseases showed that L-carnitine supplement could cause an increase in plasma tPA and a decrease in plasma PAI-1.…”

Section: Introductionmentioning

confidence: 99%

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Effects ofL-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

et al. 2010

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Background: Hypercoagulability is an important risk factor for thrombosis and its complications in hemodialysis patients. This study was designed to investigate the effects of L-carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients. Methods: Thirty-six hemodialysis patients were randomly assigned to either a carnitine or a placebo group. Patients in the carnitine group received 1000 mg/day oral L-carnitine for 12 weeks, whereas patients in the placebo group received a corresponding placebo. At baseline and the end of week 12, 5 mL blood was collected after a 12-to 14-hour fast and plasma fibrinogen concentration, activity of plasma protein C, coagulation factors V, VII, IX, and serum concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), free carnitine, and C-reactive protein (CRP) were measured. Results: In the carnitine group, mean serum free carnitine concentration increased significantly to 150% of baseline (p < 0.001), whereas plasma fibrinogen and serum CRP had 98 mg/dL (p < 0.01) and 41% (p < 0.01) significant decreases, respectively, at the end of week 12 compared with baseline. The reductions were significant compared with the placebo group (p < 0.05). No significant differences were observed between the two groups with regard to mean changes of the activity of plasma protein C, coagulation factors V, VII, IX, and serum PAI-1 to tPA ratio. Conclusion: L-Carnitine supplement reduces serum CRP, a marker of systemic inflammation, and plasma fibrinogen, an inflammation-related coagulation factor, in hemodialysis patients. Therefore, L-carnitine may play an effective role in preventing cardiovascular diseases in these patients.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Effects ofL-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

et al. 2010

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“…The most reproducible coagulation abnormalities are high levels of fibrinogen and factor VIII, which have been identified as independent biomarkers of renal insufficiency and cardiovascular events [30][31][32]. In our series of patients, factor VIII and fibrinogen levels were significantly higher in hemodialysis patients than in controls, whereas factor VII and factor IX levels were similar in patients and controls.…”

Section: Discussionmentioning

confidence: 50%

A prospective study of the prevalence of heparin‐induced antibodies and other associated thromboembolic risk factors in pediatric patients undergoing hemodialysis

et al. 2006

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Heparin, which is used at high doses in hemodialysis patients, may induce antibodies favoring thromboembolic complications. We prospectively investigated the prevalence of heparininduced platelet-reactive antibodies in a cohort of 38 pediatric hemodialysis patients, by means of heparin/platelet factor 4 (H/PF4) ELISA and heparin-induced platelet activation assay (HIPA). We also assessed other acquired and congenital hypercoagulable states. Heparin-induced antibodies were detected in 13 and 21% of patients with HIPA and ELISA, respectively. Anti-H/PF4 antibodies were negatively correlated with the number of hemodialysis sessions. These antibodies disappeared after a median time of 6 months despite continuing heparin treatment. The prevalence of antiphospholipid antibodies was 21% (anticardiolipin 10.5%, anti-b2GPI 13%, and lupus anticoagulant 5%). Blood levels of homocysteine, factor VIII, and fibrinogen were significantly higher and factor II levels were significantly lower in hemodialysis patients than in controls, whereas factor VII, factor IX, and natural coagulation inhibitor levels were similar in patients and controls. Overall, 26 of 38 patients had at least one biomarker of hypercoagulability, but only 1 patient, without anti-H/PF4 antibodies, presented with thrombosis. In conclusion, heparin induces the transient production of anti-H/PF4 antibodies in children undergoing hemodialysis, but other abnormalities probably contribute to hypercoagulability. These findings may help to improve the diagnosis and management of thrombotic events in hemodialysis patients. Am. J. Hematol. 81:328-334, 2006. V V C 2006 Wiley-Liss, Inc.

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“…Study explored the correlation between baseline FMD and subsequent change in the diameter of the artery and vein at 3 months after AVF creation and found a positive correlation. Erdem et al discovered that during haemodialysis, turbulent flow, intraluminal pressure, and regular needle insertion caused endothelial damage, which led to haemostatic activation in AVF [46]. Wakefield et al's study indicated that thrombus development and blood clotting could be stimulated by higher levels of factor V, plasminogen activator inhibitor-1, tissue factor, and von Willebrand factor, as secreted by a dysfunctional venous endothelium [47].…”

Section: Endothelium Dysfunction and Avf Maturationmentioning

confidence: 99%

An overview of AVF maturation and endothelial dysfunction in an advanced renal failure

et al. 2017

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Life expectancy in patient with established kidney failure is considerably shortened with worsening quality of life. Through the provision of renal replacement therapy, survival and quality of life of advanced renal disease patients can be markedly improved. Haemodialysis and peritoneal dialysis are the treatment modalities in patients with end-stage renal disease. The efficiency of haemodialysis treatment relies on the functional status of vascular access. Vascular access and its related problems represent the main factors that determine a rise in the rate of incidence of the disease among haemodialysis patients and, consequently, a rise in the healthcare expenses. Arteriovenous fistula is the most efficient method, as it has a low risk of infection and mortality, and can ensure long-term functional access. However, maturation of an arteriovenous fistula is a complex process and is not well understood; significant numbers of arteriovenous fistula fail to develop sufficiently prior to their use for haemodialysis due to either lack of vessel maturation or spontaneous thrombosis. There are multiple blood markers and human factors that contribute to the maturation of fistula. Endothelial function is one of the most important determinants of arteriovenous fistula maturation. Early fistula failure is usually due to thrombosis which can be triggered by haematoma, by low flow rates resulting from low blood pressure, or by a hypercoagulable state. Impairment of endothelial function is associated with decreased arterial remodelling and final venous lumen diameter. Arteriovenous fistula anastomoses need early proliferation of endothelial cells to restore the barrier, permeability, and biochemical monitoring roles of endothelial cells in managing vascular repair, local thrombosis, neointimal hyperplasia, and inflammation. The purpose of this review was to discuss the maturation of AVF and endothelial dysfunction.

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Coagulation, fibrinolysis and fibrinolysis inhibitors in haemodialysis patients: contribution of arteriovenous fistula

Abstract: In addition to systemic derangements of haemostasis in ESRD patients, AVF individually might have a substantial role in the modulation of coagulation and fibrinolytic cascade.

Cited by 25 publications

References 0 publications

Effects ofL-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

Effects ofL-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

A prospective study of the prevalence of heparin‐induced antibodies and other associated thromboembolic risk factors in pediatric patients undergoing hemodialysis

An overview of AVF maturation and endothelial dysfunction in an advanced renal failure

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