Enhanced fibrinolytic activity during the course of hemodialysis
Nakamura, Y.; Tomura, S.; Tachibana, K.; Chida, Y.; Marumo, F.
Clinical Nephrology 38(2): 90-96
1992
ISSN/ISBN: 0301-0430 PMID: 1387598 Document Number: 399268
In order to clarify the effect of hemodialysis (HD) on the fibrinolytic system, fibrinolytic activity was evaluated in 27 patients undergoing regular hemodialysis treatment (RDT) using new parameters including plasma alpha2-plasmin inhibitor (.alpha.2PI), alpha2-plasmin inhibitor-plasmin complex (.alpha.2PIC), cross-linked fibrin degradation products (XL-FDP), tissue plasminogen activator (t-PA) activity, t-PA antigen and plasminogen activator inhibitor-1 (PAI-1) antigen. Predialysis baseline levels of plasminogen and .alpha.2PI activity in RDT patients were significantly lower and those of .alpha.2PIC were significantly higher than normal control values. During a single HD session, .alpha.2PIC exhibited a continuous, significant increase reaching about 180% of initial values by the end of HD. .alpha.2PIacteivity was significantly decreased at the end of the HD, though there were no significant changes in plasminogen activity during HD. Predialysis baseline levels of XL-FDP in RDT patients were significantly higher than normal control values. No significant changes in XL-FDP were observed during HD. Both t-PA activity and t-PA antigen significantly increased during HD, and PAI-1 antigen significantly decreased during HD. Von Willebrand factor (vWF) antigen in plasma, which is regarded as reflecting a release reaction by vascular endothelial cells to certain stimuli, also significantly increased during HD. However, neither vWF antigen nor t-PA antigen was increased by heparin administration alone. The changes in .alpha.2PI and .alpha.2PIC levels suggest that fibrinolytic activity is slightly higher in RDT patients and is even higher during HD. An increase in the release of t-PA from endothelial cells together with the consumption of PAI-1 is likely to be a leading cause of enhanced fibrinolytic activity during HD.