RELATIONSHIP BETWEEN ELEVATION IN THE PLASMA-CONCENTRATION OF ELASTASE-ALPHA(1) PROTEINASE-INHIBITOR COMPLEX (E-ALPHA-1PI) AND HEMOSTATIC PARAMETERS DURING HEMODIALYSIS

To investigate the relationship between changes in plasma concentratio ns of polymorphonuclear elastase (PMN-E) and haemostatic effects durin g haemodialysis (HD), changes in the plasma concentrations of elastase -alpha, proteinase inhibitor complex (E-alpha(1)PI) and fibrinogen (Fb g), cross-linked fibrin degradation products (XDP), thrombin-antithrom bin III complex (TAT), plasmin-alpha(2) plasmin inhibitor complex (PIG ) and soluble thrombomodulin (TM) in 49 patients with end-stage chroni c glomerulonephritis maintained on chronic HD were measured. Plasma co ncentrations of TAT, PIC, TM and E-alpha(1)PI significantly increased during a single HD. There was a statistically significant correlation between change in plasma E-alpha(1)PI concentration and changes in pla sma concentrations of TAT, PIC and TM during a single HD, as well as b etween changes in plasma concentrations of TM and TAT during a single HD. These observations suggested that activation of coagulation and fi brinolysis, endothelial cell damage, and activation of polymorphonucle ar cells occur during HD. Activation of polymorphonuclear cells may in duce activation of coagulation and fibrinolysis, leading to endothelia l cell damage, augmented by release of proteases such as elastase.