Plasma Thrombomoduhn: Usefulness as a Blood Access Failure Marker in Hemodialysis Patients

Abstract

In 144 patients on hemodialysis (76 males and 68 females, median age 55.7 ± 14.1 years, mean period on dialysis 44.1 ± 33.3 months), thrombomodulin was determined by enzyme immunoassay prior to initiation of hemodialysis. The results showed that the mean thrombomodulin value of hemodialysis patients was 13.59 ± 3.63 ng/ml which was significantly higher than the control value (3.20 ± 0.90 ng/ml). The thrombomodulin values were significantly higher in patients with blood access failure (15.27 ± 4.45 ng/ml) than in those without (13.11 ± 3.31 ng/ml), and the rate of blood access failures was also significantly higher in those with thrombomodulin values of 15.0 ng/ml or higher than in those with values < 15.0 ng/ml. It was evident that there is a higher risk of blood access failure in patients with severe systemic vascular endothelial injury, and thrombomodulin is a useful marker of such an injury.

Low Plasma Activated Protein C-Protein C Inhibitor Complex Concentration Is Associated with Vascular Access Failure in Hemodialysis Patients

“…In addition, patients with impaired kidney function have higher than normal levels of P-TM-ag. We were not able to confirm that postdialysis P-TM-ag levels were significantly elevated compared to predialysis levels [10,11,12,13] or that the P-TM-ag values were correlated with failure of the vascular access [14, 15]. Our results regarding P-TM-ag are supported by the fact that we also measured P-TM-act, which was not correlated with the failure of vascular access.…”

“…Significantly elevated predialysis plasma levels of soluble plasma TM fragments (P-TM-ag) have been demonstrated in HD patients relative to healthy controls [5,6,7,8,9,10]. In addition, postdialysis P-TM-ag levels have been shown to be significantly elevated compared to predialysis levels [11,12,13]. Finally, P-TM-ag values have been found to correlate with the failure of vascular access [11, 12].…”

“…In addition, postdialysis P-TM-ag levels have been shown to be significantly elevated compared to predialysis levels [11,12,13]. Finally, P-TM-ag values have been found to correlate with the failure of vascular access [11, 12]. The concentration of the complex between APC and PCI in plasma (P-APC-PCI complex) is an indirect measure of the amount of APC.…”

Transforming Growth Factor-β₁ May Be Involved in Shunt Obstruction in Patients on Chronic Hemodialysis

“…Our previous study suggested that the plasma level of thrombomodulin was a useful marker of vascular intimal injury in hemodialysis patients with blood-access failure [4]. Nakayama et al [5]reported that the plasma thrombomodulin level reflects injury to the vascular intima, and suggested that there is ongoing vascular damage in patients on regular hemodialysis or continuous ambulatory peritoneal dialysis.…”