Intraperitoneal hypercoagulation and hypofibrinolysis is present in childhood peritonitis

Abstract

An increased rate of obstruction of peritoneal dialysis catheters is observed during peritonitis. Hypercoagulation and hypofibrinolysis may explain this increased occurrence. We studied plasminogen activator inhibitor type 1 antigen (PAI-1), tissue-type plasminogen activator antigen (t-PA), D-dimer (DD), plasmin-alpha2-antiplasmin complexes (PAP), and thrombin-antithrombin III complexes (TAT) in 7 children with peritonitis (group A) and 12 children during stable peritoneal dialysis (group B). Albumin, beta2-microglobulin, IgG, and alpha2-macroglobulin were measured for baseline transperitoneal protein transport. After a dwell of 6 h with 1.36% Dianeal, dialysate and serum samples were collected. Dialysate to plasma ratios of all proteins were calculated. During peritonitis (group A) TAT was higher: 34.7 versus 22.0 (P=0.01). PAI-1 was increased in group A: 76.5 versus 22.9 (P=0.004). PAP was decreased during peritonitis (group A): 24.9 versus 39.3 (P=0.01). In group A, DD were decreased. 10.8 versus 26.7 (P=0.002). t-PA was similar in both groups (23.7 in group A vs. 27.7 in group B; P=0.26). In both groups TAT, PAI-1, t-PA, PAP, and DD were significantly higher than in baseline transperitoneal transport, suggesting intraperitoneal production. Hypercoagulability and hypofibrinolysis were present during peritonitis compared with the control situation.

Dialysis-associated peritonitis in children

“…Adjuvant therapy Patients with extremely cloudy effluent may benefit from the addition of low-dose heparin (500–1000 U/L) into the dialysate as it can help prevent occlusion of the catheter due to fibrin, which is often present as a result of the inflammatory process [96]. As infants receiving CPD with peritonitis can lose substantial amounts of gamma globulin across an inflamed peritoneum, they may benefit from intravenous immunoglobulin (Ig) therapy, especially if they have low measured IgG levels and/or they appear septic [97, 98].…”

Can Effluent Matrix Metalloproteinase 2 and Plasminogen Activator Inhibitor 1 be Used as Biomarkers of Peritoneal Membrane Alterations in Peritoneal Dialysis Patients?

“…Elevated levels of PAI-1 are present in the peritoneal tissue of surgical patients with intra-abdominal adhesions (11,12). Expression of PAI-1 is also intensified and widely distributed in submesothelial tissue during peritonitis in PD patients (13,14).…”

Comparison of intraperitoneal antithrombin III and heparin in experimental peritonitis

“…Both serum and dialysate levels of AT-III were found to be high in patients with CAPD, although there was a continuous loss of large amounts of AT-III within the dialysate fluid, and this was explained as being due to some compensatory mechanisms [7,8]. It was also shown that the levels of thrombin-antithrombin complex increase, whereas tissueplasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) decrease in patients with peritonitis who were on CAPD [4].…”

“…The efficiency of heparin, which is used to decrease fibrin production in patients with peritonitis, may be limited [3,4]. It was shown in previous studies that thrombin production, which has an important role in fibrin production, increases in patients with severe peritonitis [4]. However, the effect of antithrombin III (AT-III), which inactivates thrombin formation by making a complex with thrombin and antithrombin, is not entirely known in peritonitis.…”

“…Reduction in fibrin production and inhibition of fibrosis formation in the peritoneal membrane may potentially block ultrafiltration failure. The efficiency of heparin, which is used to decrease fibrin production in patients with peritonitis, may be limited [3,4]. It was shown in previous studies that thrombin production, which has an important role in fibrin production, increases in patients with severe peritonitis [4].…”