Structural changes in carotid arteries and impairment of fibrinolysis in hemodialyzed and peritoneally dialyzed patients
Jolanta Małyszko, Urszula Lebkowska, Jacek S. Małyszko, Michał Myśliwiec
Med Sci Monit 2009; 15(12): CR644-649
Cardiovascular disease (CVD) is leading cause of death in patients on renal replacement therapy. Increased concentration of fibrinogen, dyslipidemia, and impaired fibrinolysis are regarded as important risk factors for CVD. Intima media thickness (IMT) of the common carotid artery is related to coronary and cerebrovascular arterial disease. Thrombin-activatable fibrinolysis inhibitor (TAFI) is a recently discovered inhibitor of the fibrinolytic system. The aim of study was to evaluate whether IMT is related to the hemostatic factors prothrombin fragments 1+2 (F 1+2), thrombin-antithrombin (TAT) complexes, plasmin-antiplasmin (PAP) complexes, fibrinogen, euglobulin clot lysis time (ECLT), TAFI, and thrombomodulin in peritoneally dialyzed (PD) and hemodialyzed (HD) patients.
Material and Method: The study included 80 chronically dialyzed patients (27 on PD, 53 on HD). The hemostatic parameters were measured with commercially available kits.
Results: Significant positive correlations were found between fibrinogen or triglycerides and TAFI activity only in the PD patients. In univariate analysis, IMT correlated significantly with age, cholesterol, CRP, fibrinogen, hemoglobin, prothrombin time, activated partial thromboplastin time, and iron in the PD patients. In multiple regression analysis, IMT was only independently related to age and cholesterol in PD patients. In HD patients, IMT correlated with age, prothrombin time, and iron and in multiple regression analysis IMT was only independently related to age.
Conclusions: The correlations between IMT and Hb may imply a role of these rheological factors in the progression and acceleration of arterial remodeling in the PD population. Age remains the most significant predictor of IMT in both dialyzed populations
Keywords: Risk Factors, Renal Dialysis - adverse effects, Prothrombin, Peritoneal Dialysis, Continuous Ambulatory - adverse effects, Peptide Hydrolases - blood, Peptide Fragments - blood