Protein C, Protein S, and Antithrombin III Levels in Patients on Continuous Ambulatory Peritoneal Dialysis and Hemodialysis

Lai, Kar Neng; Yin, Jun; Yuen, Patrick Man Pan; Li, Philip K.T.

doi:10.1159/000186153

Cited by 23 publications

(12 citation statements)

References 6 publications

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“…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. In contrast to previous studies [7,33,34], we found no significant difference in the levels of natural coagulation inhibitors (AT, proteins C and S) between hemodialysis patients and controls. Decreases in the levels of natural coagulation inhibitors may result from hemodialysis itself or the type of underlying nephropathy, particularly for nephrotic syndrome [7,33,34].…”

Section: Discussioncontrasting

confidence: 99%

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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Section: Discussioncontrasting

confidence: 99%

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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“…Continuous ambulatory peritoneal dialysis (CA PD ) does not routinely employ heparin. However, C A P D may result in the loss of natural anticoagulant factors and plasma coagulation fac tors [11,12] in the dialysate. Furthermore, platelet activation has been reported as a consequence o f hypo-albuminaemia and altered prostaglandin synthesis [13,14], Previously, the assessment of haemostasis and coagula tion in uraemia and the effect o f both haemodialysis and C A P D on these variables relied upon individual tests, such as the measurement of the plasma level of clotting factors, platelet adhesion to glass beads and platelet aggregation.…”

mentioning

confidence: 99%

Comparison of Haemostatic Activity in Haemodialysis and Peritoneal Dialysis Patients with a Novel Technique, Haemostatometry

Roger

Piper²,

Tucker³

et al. 1992

Nephron

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Bleeding due to impaired primary haemostasis is common in uraemia. However, thromboembolic episodes are also a clinical problem in dialysis patients. Platelet reactivity to shear stress (haemostasis, H1 and H2), exposure to collagen fibre (thrombus growth) and coagulation of flowing blood (clotting time, CT1 and CT2) were measured in non-anticoagulated blood samples taken immediately before and 18-24 h after haemodialysis (n = 26) and from patients maintained on continuous ambulatory peritoneal dialysis (CAPD, n = 30). H1 (p < 0.001), H2 (p < 0.01), percent thrombus growth rate (p < 0.03), CT1 (p < 0.01 and CT2 (p < 0.05) were restored towards normal after haemodialysis. Results obtained in the CAPD patients demonstrated that the mean values for formation of the haemostatic plug lay between the pre- and posthaemodialysis values; however, CT1 (p < 0.01) and CT2 (p < 0.05) were prolonged in CAPD compared with values after haemodialysis. These data, which indicate platelet function from non-anticoagulated blood and coagulation under flow conditions, (1) confirm that there is impaired haemostasis in uraemia; (2) demonstrate an improvement in haemostasis after haemodialysis; (3) show that peritoneal dialysis results in a haemostatic profile which falls between the pre-and posthaemodialysis pattern, and (4) show that neither dialysis modality returns haemostasis to normal.

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“…3 Correlation between protein Z and fibrinogen levels (r=0.51; p<0.001) serum lipids, lipoprotein (a), and cytokines. On the contrary, Lai et al [26] reported that PD patients had higher plasma levels of PC, PS, and AT III than in HD patients despite greater daily losses through urinary and peritoneal routes. The authors suggested an effective turnover and production of these natural coagulation inhibitors in patients on PD therapy.…”

Section: Discussionmentioning

confidence: 94%

“…While some studies report a more hypercoagulable state in one dialysis modality some others suggest the opposite. Increased or normal levels of PS, PC and AT III have been reported in PD patients whereas PC and PS levels were found to be decreased in HD patients [5,7,[26][27][28]. Malyszko et al [29] reported a more hypercoagulable state in PD patients than in HD patients in their study investigating platelet aggregation, hemostatic parameters, Fig.…”

Section: Discussionmentioning

confidence: 99%

Protein Z and natural anticoagulants in children on peritoneal dialysis and hemodialysis

et al. 2007

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Hemostatic alterations due to abnormalities in the coagulation and fibrinolytic system may occur in dialysis patients. Protein Z (PZ) is a vitamin K-dependent coagulation protein promoting assembly of thrombin with phospholipid vesicles. The aim of this study was to investigate PZ and natural anticoagulants in children on hemodialysis (HD) and peritoneal dialysis (PD). Protein Z, protein C (PC), protein S (PS), antithrombin III (AT III), and fibrinogen levels were studied in 24 PD, 13 HD patients and 23 controls. Plasma PZ levels in patients on HD were significantly higher than those on PD and control group (p = 0.04, p = 0.03). We observed elevated PC, PS and AT III activities in children on PD when compared to controls (p = 0.011, p = 0.003, p < 0.001). In HD patients, only PS activity was increased compared to controls (p = 0.016). PC and PS activities did not differ between PD and HD patients whereas AT III activity was higher in PD patients compared to HD patients (p < 0.001). Normal/high levels of PC, PS and AT III suggest that children on PD or HD treatment do not seem to have an increased risk of thrombogenesis due to reduction of these proteins. Increased PZ levels, however, might contribute to the hemostatic alterations in children on HD treatment along with other well known abnormalities.

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Protein C, Protein S, and Antithrombin III Levels in Patients on Continuous Ambulatory Peritoneal Dialysis and Hemodialysis

Cited by 23 publications

References 6 publications

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

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

Comparison of Haemostatic Activity in Haemodialysis and Peritoneal Dialysis Patients with a Novel Technique, Haemostatometry

Protein Z and natural anticoagulants in children on peritoneal dialysis and hemodialysis

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