In vivo Platelet Hyperreactivity, another Risk Factor for Patients under Continuous Ambulatory Peritoneal Dialysis

Abstract

A high mortality rate due to thromboembolic accidents has been described in patients undergoing chronic haemodialysis. This type of complications, although recognized, has not been appropriately evaluated in continous ambulatory peritoneal dialysis patients. The present study demonstrates that continuous ambulatory peritoneal dialysis patients present in vivo platelet hyperreactivity, as evidenced by enhanced platelet responses to epinephrine ex vivo and an increased MDA/MDA_a index which traduces a decreased threshold for activation of the arachidonate pathway and subsequent thromboxane production. Since the etiopathogeny of this platelet abnormality seems to be related to abnormalities in lipid metabolism, compounds such as fish oil must be beneficial in the management of this risk factor.

Hypercoagulability and Secondary Hyperf ibrinolysis May Be Related to Abnormal Lipid Metabolism in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

“…Hypercoagulability and secondary hyperfibrinolysis have also been noted in CAPD patients [2,[20][21][22][23][24] although they do not require anticoagulants for extracor poreal circulation during dialysis and the mechanism involved is unclear. In recent years, it has become possible to measure many of the markers produced during coagu lation and fibrinolysis [4,5,25,26], In the present study, FIX.…”

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

“…There have been few reports ad dressing the possibility of platelet activation in C A P D patients [30]. Increased platelet aggregation to adrenaline has been described in both C A P D and haemodialysis pa tients [13,31], and Sabo et al [13] reported a lower threshold for secretion o f malondialdehyde from platelets in C A P D patients. They concluded that this marker of enhanced platelet activation was secondary to the hypertriglyceridaemia which was present in their group o f patients.…”

“…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. These approaches do not allow an overall assessment of the haemostatic profile.…”

Systemic immunosuppressive therapy inhibits in-stent restenosis in patients with renal allograft

“…Deposition of calcium within the plaques may lead to procedural complications, such as stent edge dissections that may increase the degree of vascular injury and thus predispose to restenosis in the long run [46]. Increased platelet aggregability [47, 48]. Activation of the coagulation system after contact with hemodialysis memebranes [49].…”