Some Aspects of Hemostasis in CAPD Patients Treated with Erythropoietin

Abstract

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.

Endothelial Cell Injury Markers in Chronic Renal Failure on Conservative Treatment and Continuous Ambulatory Peritoneal Dialysis

“…None of the investigated patients had received blood transfusions for at least 1.5 months and no drugs known to affect hemostasis were administered for at least 2 weeks prior the study. None of the patients investigated (both CAPD and CRF patients) were treated with rHuEPO or statins since both of these drugs are known to affect hemostasis as shown previously [17,18]. All the CRF subjects were biopsied and histopathological diagnosis was established as follows: IgA nephropathy in 8 cases, membranoproliferative glomerulonephritis in 4 cases, membranous nephropathy in 4 cases, focal segmental glomerulosclerosis in 4 cases, and submicroscopic glomerulonephritis in 1 case.…”

Comprehensive review of cardiovascular toxicity of drugs and related agents

“…Enhanced platelet aggregation, impaired endothelial function, and erythropoietin antibodies have been proposed as contributing mechanisms for its prothrombotic effects, but the results are contradictory. New onset hypertension or worsening of existing hypertension is relatively common and is associated with increased plasma volume …”

Lipids, Blood Pressure, Kidney-what was New in 2012?

“…According to the revised indication, ESA therapy should be considered when the haemoglobin level is less than 10 g/dl in CKD and dialysed patients. Erythropoietin stimulating agents dose should be reduced or ESA should be withdrawn when haemoglobin exceeds 10 g/dl in CKD patients and approaches or exceeds 11 g/dl in dialysed patients [155][156][157][158]. During ASN Prof. Parfrey presented new guidelines on anaemia treatment; however, it is anticipated that these guidelines will be published in early 2012 (KDIGO Clinical Practice Guideline on Anemia in CKD, chaired by Drs.…”