Increased renal allograft thrombosis in CAPD patients

Murphy, B G; Hill, Claire; Middleton, Derek; Doherty, C C; Brown, John H.; Nelson, W E; Kernohan, R. M.; Keane, P. K.; Douglas, John; McNamee, P

doi:10.1093/ndt/9.8.1166

Cited by 66 publications

(33 citation statements)

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“…Nevertheless, the circulating levels of tPA are considered to be a reasonable indication of fibrinolytic activity that correlates with the propensity to thrombosis. It is for this reason that an etiologic role for low tPA levels has been implicated in the propensity to increased renal allograft thrombosis of transplanted CAPD patients [47], and in the thrombotic episodes observed in children on CAPD [30]. Graft loss from primary renovascular thrombosis has been reported to occur in 7.1% of CAPD recipients as opposed to an occurrence rate of 1.8% in hemodialysis patients [47].…”

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confidence: 99%

“…It is for this reason that an etiologic role for low tPA levels has been implicated in the propensity to increased renal allograft thrombosis of transplanted CAPD patients [47], and in the thrombotic episodes observed in children on CAPD [30]. Graft loss from primary renovascular thrombosis has been reported to occur in 7.1% of CAPD recipients as opposed to an occurrence rate of 1.8% in hemodialysis patients [47]. The plasma albumin concentration in children showing an abnormality in fibrinolytic activity was below 3.3 g/dl [30].…”

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confidence: 99%

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Does the Choice of Renal Replacement Therapy Adversely Affect the Hypercoagulability Associated with Renal Disease?

Assouad

Eknoyan²

1998

Am J Nephrol

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Both a bleeding diathesis and a tendency to hypercoagulability occur in the course of renal disease. More common and consistent in occurrence during the progression of renal failure to end-stage renal disease is the hemostatic defect. The principal cause of this abnormality is the uremic state and, as a rule, it is reversible following the institution of adequate renal replacement therapy and correction of the anemia with epoietin. By contrast, the tendency to hypercoagulability is usually encountered in patients with the nephrotic syndrome and shows a correlation to the degree of hypoalbuminemia, being more evident at serum albumin levels of < 2 g/dl. Although the coagulopathy is complex in pathogenesis, a defect in the fibrinolytic process plays a critical role in its development. A tendency to pro-thrombosis due to abnormal fibrinolysis has been identified also in patients on renal replacement therapy with continuous ambulatory peritoneal dialysis (CAPD). The observed coagulation abnormalities resemble those of the nephrotic syndrome. Although its etiology remains undefined, a role for the albumin losses in the peritoneal dialysate has been implicated in the prothrombotic state that occurs in some CAPD patients.

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confidence: 99%

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confidence: 99%

Does the Choice of Renal Replacement Therapy Adversely Affect the Hypercoagulability Associated with Renal Disease?

Assouad

Eknoyan²

1998

Am J Nephrol

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“…Well recognized risk factors for RGT include technical surgical problems [l, 3, 41, vessel torsion or compression, perioperative hemodynamic status [ 11, past history of venous thrombosis [l, 71, diabetic nephropathy of recipient [l, 21, donor's right kidney [l], discrepancy in the size between donor and recipient vessels, immunosuppressive therapy (cyclosporin, OKT3) [l, 2,7], and prolonged cold ischemia time [l, 71. Other risk factors include peritoneal dialysis [5], membranous glomerulopathy and multiple graft vessels [l, 31.…”

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confidence: 99%

Successful endoluminal thrombo-aspiration of renal graft venous thrombosis

Rérolle¹,

Antoine²,

Raynaud³

et al. 2000

Transplant International

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“…As has been reminded in the Introduction, patients with chronic renal failure, including those treated by peritoneal dialysis, develop -in addition to hemorrhagic diathesisat an earlier time point and more often than the general population atherosclerosis with its thrombotic complications and have thromboses also in other localizations [1][2][3][4]. A reduced tPA activity in CAPD patients along with other previously reported changes in hemostasis and fibrinolysis [4,[20][21][22] may play a role in the development of these problems.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, an additional challenge in peritoneal dialysis is the specific problem of the coagulation and fibrinolysis systems in the peritoneal cavity investigated with a special view on fibrin formation on the peritoneum. Both thrombosis plus atherosclerosis and increased fibrin formation are associated with fibrinolysis disorders [1][2][3][4][5]. All these facts make study of fibrinolysis in patients on peritoneal dialysis a necessity.…”

Section: Introductionmentioning

confidence: 99%

Tissue-Type Plasminogen Activator (tPA) and Its Inhibitor (PAI-1) in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

Opatrný

Opatrná²,

L³

1998

Am J Nephrol

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Aim: To establish whether the values of two key enzymes of fibrinolysis, tissue-type plasminogen activator (tPA) and its inhibitor (PAI-1), differ between patients treated with continuous ambulatory peritoneal dialysis (CAPD) and healthy volunteers and whether plasma and dialysate tPA and PAI-1 values vary during one exchange of dialysis solution. Methods: A total of 11 patients with chronic renal failure, treated with CAPD during the peritoneal equilibration test (in addition with blood sampling at time 0), and a control group of 11 healthy volunteers were examined. To identify the factors involved in the changes in tPA and PAI-1, 9 CAPD patients were subsequently monitored, in a crossover manner, during dialysis with solutions of 1.36 and 3.86% dextrose and off dialysis. Results: Compared with healthy individuals, CAPD-treated patients showed a significantly lower tPA activity (0.39 vs. 0.81 IU/ml, p < 0.05). Changes in plasma fibrinolysis during one exchange of dialysis solution were characterized mainly by a decrease in PAI-1 concentrations and activities caused by the circadian rhythm of fibrinolysis. To explain, in the crossover part of the study, the values of plasma PAI-1 antigen at time 0 (07.00 h) and at time 2 (09.00 h) were 9.4 versus 6.5 ng/ml with the 1.36% solution (p < 0.05), 8.2 versus 4.9 with the 3.86% solution (p < 0.05), and 14.1 versus 9.1 ng/ml off dialysis (p < 0.01). Compared to baseline (0 ng/ml with 1.36 as well as 3.86% solutions), the levels of PAI-1 antigen in dialysis solution rose, apparently due to local production in the peritoneal cavity, to 0.5 ng/ml (p < 0.05) with the 1.36% solution, to 0.7 (p < 0.05) with the 3.86% solution after a 2-hour dwell time, and to 1.6 (p < 0.05) and 1.3 ng/ml (p < 0.05) after a 4-hour dwell time, respectively. Hence, the different dextrose levels in the dialysis solutions had no effect on the monitored parameters of fibrinolysis. Conclusion: The lower activity of plasma tPA, and the increase in PAI-1 levels in dialysis solutions may contribute to the development of thromboses in CAPD patients and to fibrin formation on the peritoneal surface with consequences such as peritoneal fibrosis.

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Increased renal allograft thrombosis in CAPD patients

Cited by 66 publications

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Does the Choice of Renal Replacement Therapy Adversely Affect the Hypercoagulability Associated with Renal Disease?

Does the Choice of Renal Replacement Therapy Adversely Affect the Hypercoagulability Associated with Renal Disease?

Successful endoluminal thrombo-aspiration of renal graft venous thrombosis

Tissue-Type Plasminogen Activator (tPA) and Its Inhibitor (PAI-1) in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

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