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Huang YJ, Xiong LP, Zhang X, Zhou JF, Zhang R. Higher D-dimer and activated partial thromboplastin time are poor prognostic factors in patients with peritoneal dialysis-related peritonitis. Ther Apher Dial 2023; 27:918-925. [PMID: 37357362 DOI: 10.1111/1744-9987.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Coagulation system dysfunction is associated with adverse outcomes of peritoneal dialysis (PD) and bacterial infection. We investigated the association between coagulation system and treatment failure of peritoneal dialysis-related peritonitis (PDRP). METHODS We collected records of patients aged ≥18 years with PDRP. PDRP episodes were divided into: shortened activated partial thromboplastin time (APTT) group and prolonged APTT group, low D-dimer (DD) group and high DD group. The baseline characteristics of the groups were collected and compared. The association between APTT, DD and treatment failure of PDRP was analyzed using logistic regression analysis. RESULTS Thirty episodes of treatment failure were observed in 110 episodes of PDRP in our study. After adjusting for variables, prolonged APTT (OR = 1.166 [1.049-1.296], p = 0.004) or high level of DD (OR = 1.374 [1.057-1.787], p = 0.017) was associated with treatment failure of PDRP. CONCLUSION Prolonged baseline APTT or high level of DD increased the risk of treatment failure of PDRP.
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Affiliation(s)
- Ya-Juan Huang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Ping Xiong
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Zhang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Fan Zhou
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Zheng H, Wang H, Zhou Z, Cai H, Liang J, Qin Y, Xia P, Chen L. End Stage Renal Failure Patients With Hemophilia Treated With Peritoneal Dialysis: A Case Series. Kidney Int Rep 2022; 7:2639-2646. [PMID: 36506225 PMCID: PMC9727524 DOI: 10.1016/j.ekir.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Currently, no consensus on optimal renal replacement modality has been reached for end-stage renal disease (ESRD) patients complicated with hemophilia. They may require infusion of coagulation factors during each hemodialysis session. In comparison, peritoneal dialysis (PD) might be preferred considering that coagulation replacement is only required for catheter placement. However, limited data on the safety and efficacy of PD for treating ESRD patients with hemophilia were reported. Methods This is a single-center retrospective cohort study. ESRD patients diagnosed with hemophilia under PD in Peking Union Medical College Hospital from January 1, 1996 to December 31, 2021 were included and followed-up with every month. Their baseline clinical data, catheter insertion procedure, coagulation factor replacement, complications, and outcome were analyzed and compared with general PD patients. Results In total, 8 patients diagnosed with hemophilia were included, all-male, with a mean age of 50.3±13.3 years old. Two were acquired hemophilia A, whereas the rest were hereditary hemophilia A (HHA). Seven patients experienced significant hemoglobin (Hgb) increment after PD. Peritoneal hemorrhage only consisted of a small portion of all hemorrhage. Patients with hemophilia seemed to have lower small solute clearance despite higher baseline peritoneal permeability, and appeared to have increased peritonitis rate than other male PD patients, yet this study is not powered to prove this. Conclusion PD is a safe and effective choice for patients with hemophilia and ESRD requiring dialysis. More studies are required to evaluate this certain rare group of patients.
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Affiliation(s)
- Hua Zheng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Haiyun Wang
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Zijuan Zhou
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Huacong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Liang
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Yan Qin
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Peng Xia
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Limeng Chen
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
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Li W, Chen W, Xie M, Huang H, Su H, Han H, Zhang D, Zhang Y, Yang X, Xu W, Su Y, Wu W, Huang Y, Fu K, Wei J. Fasudil inhibits tissue factor and plasminogen activator Inhibitor-1 secretion by peripheral blood mononuclear cells in CAPD patients. Ren Fail 2016; 38:1359-1363. [PMID: 27756191 DOI: 10.1080/0886022x.2016.1214053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Disturbances in hemostasis are common complications of kidney diseases and correlate well with cardiovascular mortality. Little is known about the effects of fasudil on tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1) expression in peripheral blood mononuclear cells (PBMCs) in CAPD patients. PBMCs were isolated from 13 individuals with CAPD and 13 healthy subjects. After 4 h of incubation with or without LPS (10 ng/mL), TF and PAI-1 mRNA of PBMCs were detected by RT-PCR. The levels of TF and PAI-1 in culture supernatants of PBMCs were determined by ELISA. Compared with healthy controls, CAPD patients had increased TF, PAI-1 protein and mRNA expression by PBMCs at baseline and after stimulated by LPS (10 ng/mL) [p < 0.001]. The fasudil treatment resulted in a significant effect in decreasing TF and PAI-1 [p < 0.05] synthesis in PBMCs. TF and PAI-1 mRNA expression and activities in PBMCs were increased in CAPD patients. Fasudil reduced LPS-mediated TF and PAI-1 expression and activity in PBMCs. These effects may partially be relevant to the clinical benefits of fasudil in the treatment of CAPD patients.
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Affiliation(s)
- Wenning Li
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Wen Chen
- b Department of Nephrology , the Second Affiliated Hospital of Hainan Medical College , Haikou , Hainan , China
| | - Maowei Xie
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Haiyang Huang
- c Central Laboratory , Hainan General Hospital , Haikou , Hainan , China
| | - Huiluan Su
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Hui Han
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Daofa Zhang
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Ying Zhang
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Xiaohong Yang
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Wentan Xu
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Yan Su
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Wei Wu
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Yun Huang
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
| | - Keying Fu
- c Central Laboratory , Hainan General Hospital , Haikou , Hainan , China
| | - Jiali Wei
- a Department of Nephrology , Hainan General Hospital , Haikou , Hainan , China
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Lutz J, Menke J, Sollinger D, Schinzel H, Thürmel K. Haemostasis in chronic kidney disease. Nephrol Dial Transplant 2013; 29:29-40. [PMID: 24132242 DOI: 10.1093/ndt/gft209] [Citation(s) in RCA: 262] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The coagulation system has gained much interest again as new anticoagulatory substances have been introduced into clinical practice. Especially patients with renal failure are likely candidates for such a therapy as they often experience significant comorbidity including cardiovascular diseases that require anticoagulation. Patients with renal failure on new anticoagulants have experienced excessive bleeding which can be related to a changed pharmacokinetic profile of the compounds. However, the coagulation system itself, even without any interference with coagulation modifying drugs, is already profoundly changed during renal failure. Coagulation disorders with either episodes of severe bleeding or thrombosis represent an important cause for the morbidity and mortality of such patients. The underlying reasons for these coagulation disorders involve the changed interaction of different components of the coagulation system such as the coagulation cascade, the platelets and the vessel wall in the metabolic conditions of renal failure. Recent work provides evidence that new factors such as microparticles (MPs) can influence the coagulation system in patients with renal insufficiency through their potent procoagulatory effects. Interestingly, MPs may also contain microRNAs thus inhibiting the function of platelets, resulting in bleeding episodes. This review comprises the findings on the complex pathophysiology of coagulation disorders including new factors such as MPs and microRNAs in patients with renal insufficiency.
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Affiliation(s)
- Jens Lutz
- Schwerpunkt Nephrologie, I. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Germany
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Haemostatic system, biochemical profiles, kynurenines and the prevalence of cardiovascular disease in peritoneally dialyzed patients. Thromb Res 2010; 125:e40-5. [DOI: 10.1016/j.thromres.2009.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 06/26/2009] [Accepted: 08/03/2009] [Indexed: 11/18/2022]
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Koracevic GP. Pragmatic classification of the causes of high D-dimer. Am J Emerg Med 2009; 27:1016.e5-7. [PMID: 19857427 DOI: 10.1016/j.ajem.2008.11.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 11/15/2008] [Indexed: 12/29/2022] Open
Abstract
Venous thromboembolism (VTE) remains the most common preventable cause of in-hospital death and D-dimer (DD) is one of the essential diagnostic tools for it. Each risk factor for VTE can raise DD and they are numerous: 24 listed in 2008 European Guidelines. Acute coronary syndrome and stroke increase DD concentration, too. Thus, all three most important causes of cardiovascular death are capable of raising DD. Recent evidence suggests DD as a sensitive marker also for acute aortic dissection. Many other processes may raise DD concentration: atrial fibrillation, congestive heart failure, disseminated intravascular coagulation, etc. The adequate DD interpretation is additionally important due to the frequent usage of the test (probably millions of times a year in the world). Simple and concise classification is much easier to remember and such one is suggested.
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Affiliation(s)
- Goran Pante Koracevic
- Medical Faculty, Department of Cardiovascular Diseases, University Clinical Centre, Nis, Serbia.
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