Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile, third quartile]) during first and second vs. consecutive exchanges in APDDD (−61 [−148, 27], 170 [78, 228] vs. 213 [126, 275] mL; p < 0.001), but not in APDWD (81 [−8, 176], 81 [−4, 192] vs. 115 [4, 219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.
Background: Bleeding diathesis and simultaneous thrombotic complications may be seen in dialyzed patients. Erythropoietin may shift the precarious balance of the hemostatic system towards thrombosis. Thrombin activatable fibrinolysis inhibitor (TAFI) is a key protein linking coagulation and fibrinolysis. Methods: The effects of 3-month erythropoietin treatment on some hemostatic parameters – TAFI, fibrinolytic activity index (FAI), markers of ongoing coagulation (thrombin-antithrombin complexes and prothrombin fragments 1 + 2), marker of ongoing fibrinolysis (plasmin-antiplasmin complexes) and marker of endothelial cell injury (thrombomodulin) – were studied in 17 patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD not treated with rHuEPO were also studied. Healthy volunteers served as a control group. 2,000 U erythropoietin was given subcutaneously three times a week. Commercially available kits were used to determine hemostatic parameters. Results: All the hemostatic parameters studied were significantly higher in CAPD patients when compared to the control group. All these hemostatic parameters except the plasmin-antiplasmin complexes did not differ significantly between patients before rHuEPO therapy and patients without rHuEPO. Erythropoietin therapy resulted in a significant decrease in plasmin-antiplasmin complexes, a significant rise in FAI after 3 months of drug administration, and a tendency to decrease the TAFI concentration and activity (after 1 month, p = 0.11 and p = 0.10, respectively; after 3 months p = 0.07 and p = 0.06, respectively). Treatment with erythropoietin did not affect platelet count, prothrombin time, activated partial thromboplastin time, cholesterol, triglycerides, fibrinogen, total protein, albumin, serum iron, ferritin, fibronectin, pH, bicarbonates, creatinine, and urea. Hemoglobin and hematocrit increased significantly after 1 month of the therapy. Conclusion: Short-term treatment with erythropoietin seems to minimally affect hemostasis in CAPD patients.
Objective Bleeding diathesis and simultaneous thrombotic complications may be seen in dialyzed patients. Erythropoietin (EPO) may shift the precarious balance of the hemostatic system toward thrombosis. Platelets and tissue factor (TF) play a major role in plug formation. Tissue factor pathway inhibitor (TFPI) appears to play a primary role in regulating TF-induced coagulation. Thrombin activatable fibrinolysis inhibitor (TAFI) is a key protein linking coagulation and fibrinolysis. The aim of the study was to assess whether 6 months of EPO therapy affects platelet function, that is, platelet aggregation and P-selectin level; moieties of the extrinsic coagulation pathway: TF, TFPI, and TFPI/Xa complexes, and factors VII and X; markers of ongoing coagulation: thrombin–antithrombin complexes (TAT) and prothrombin fragments 1+2; a marker of ongoing fibrinolysis: plasmin–antiplasmin complexes (PAP); fibrinolytic activity: euglobulin clot lysis time (ECLT); and markers of endothelial cell injury: von Willebrand factor, thrombomodulin, E-selectin, and TAFI, in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods 22 patients on CAPD were given EPO 6000 U/week. 12 patients with chronic renal failure and 12 healthy volunteers served as control groups. All parameters were studied before, and after 1, 3, and 6 months of EPO therapy. Setting Department of Nephrology and Internal Medicine, Medical Academy of Bialystok, Poland. Results Platelet aggregation in whole blood did not change significantly during EPO treatment. A significant rise in arachidonic acid-induced platelet aggregation in platelet-rich plasma was observed after 3 and 6 months, and in collagen-induced platelet aggregation after 6 months of EPO therapy, compared to the baseline values. The TFPI concentration decreased significantly after 6 months of EPO therapy. The activity of factor VII increased transiently after 1 month of EPO therapy, compared to the baseline values. The TAFI concentration and activity in the CAPD group were significantly higher than in the control group. Erythropoietin therapy resulted in a significant decrease in TAFI concentration and activity after 6 months of EPO treatment. The ECLT was shortened significantly as early as after 1 month of EPO therapy. Thrombomodulin, von Willebrand factor concentration and activity, PAP, TAT, TFPI/Xa complexes, prothrombin fragments 1+2, factor X activity, P-selectin, E-selectin, and lipoprotein(a) did not change significantly during EPO treatment. Conclusion Erythropoietin treatment has a minimal effect on hemostasis in CAPD patients. A tendency toward a decline in TAFI is of unknown clinical relevance so far, and awaits further research.
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