Document Detail


Altered fibrin clot properties in patients on long-term haemodialysis: relation to cardiovascular mortality.
MedLine Citation:
PMID:  18156458     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Haemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. Both end-stage renal disease (ESRD) and thromboembolic coronary events have been shown to be associated with the formation of dense fibrin clots resistant to fibrinolysis. The aim of the present study was to investigate the effect of long-term haemodialysis on clot structure/function and analyse an influence of markers of inflammation, oxidative stress and lipoprotein(a). We sought also to investigate if clot features might be related to CV events and mortality in haemodialysis patients. Subjects and methods. In 33 patients (19 males, 14 females), aged 27 to 89 years, on long-term haemodialysis and 33 age- and sex-matched apparently healthy controls, we investigated fibrin clot properties and susceptibility to lysis using recombinant tissue plasminogen activator by using permeation and turbidity assays. RESULTS: Haemodialysis patients produced fibrin clots that had less porous structure (P < 0.0001) were less susceptible to fibrinolysis (P < 0.0001), began fibrin protofibril formation more quickly (P < 0.0001) and showed increased overall fibre thickness (P < 0.0001) compared with controls. Clot permeability and lysis time correlated with F2-isoprostanes (P < 0.01), Lp(a) (P < 0.0001) and fibrinogen (P < 0.01). None of the clot variables showed associations with the duration of haemodialysis treatment or the cause of ESRD. During a 36-month follow-up, 10 CV deaths were recorded. Mortality was associated with reduced clot permeability (P < 0.0001), prolonged lysis time (P < 0.0001), faster fibrin protofibril formation (P = 0.0004), thicker fibres (P < 0.0001) and increased fibrin clot mass (P < 0.0001). CONCLUSIONS: Unfavourably altered clot properties can be detected in haemodialysis patients and may be associated with increased CV mortality.
Authors:
Anetta Undas; Marek Kolarz; Grzegorz Kopeć; Wiesława Tracz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-12-21
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  23     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-21     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2010-5     Citation Subset:  IM    
Affiliation:
Institute of Cardiology, Jagiellonian University School of Medicine, Cracow, Poland. mmundas@cyf-kr.edu.pl
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Coagulation / drug effects,  physiology
Cardiovascular Diseases / etiology,  mortality
Case-Control Studies
Cohort Studies
Coronary Thrombosis / etiology*,  mortality*,  physiopathology
Female
Fibrin / drug effects,  metabolism*
Fibrin Fibrinogen Degradation Products / metabolism
Fibrinolytic Agents / administration & dosage
Humans
Kidney Failure, Chronic / blood,  mortality,  therapy*
Long-Term Care
Male
Middle Aged
Nephelometry and Turbidimetry
Permeability
Probability
Reference Values
Renal Dialysis / adverse effects*,  methods
Risk Assessment
Statistics, Nonparametric
Survival Analysis
Chemical
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/Fibrinolytic Agents; 9001-31-4/Fibrin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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