Effect of increasing serum albumin on plasma D-dimer, von Willebrand factor, and platelet aggregation in CAPD patients

This study was performed to investigate the interrelation between blood alb umin level and D-dimer (a marker of intravascular coagulation) and von Will ebrand factor (VWF; a marker of endothelial injury) levels or platelet aggr egation. Blood levels of albumin, D-dimer, vWF, and C-reactive protein (CRP ) and the threshold aggregating concentration (TAC) of ristocetin were meas ured in 64 continuous ambulatory peritoneal dialysis (CAPD) patients and co mpared with 36 healthy controls. Twenty-two CARD patients with albumin leve ls less than 3.0 g/dL were divided into experimental and disease-control gr oups. In the experimental group, levels were measured before and after repe ated infusions of 20% albumin, 100 mL/d for 7 days. The same parameters wer e measured in the disease control group that did not receive the albumin in fusion. CAPD patients had higher D-dimer and vWF levels than the healthy co ntrols. There were inverse correlations between albumin and D-dimer (r = -0 .48; P < 0.001), vWF (r = -0.29; P < 0.05), or logCRP (r = -0.44; P < 0.001 ) in CAPD patients. There were positive correlations between logCRP;and D-d imer (r = 0.38; P < 0.01) and between logCRP and vWF (r = 0.32; P = 0.01) i n CAPD patients. No change was seen in D-dimer, vWF, and CRP levels in eith er group. The TAC of ristocetin in the 18 CAPD patients was not different f rom that in the 11 healthy controls (0.55 +/- 0.09 v 0.65 +/- 0.07 mg/mL). There was a correlation between albumin level and TAC in the CAPD patients (r = 0.59; P < 0.01). TAC increased from 0.50 +/- 0.09 to 0.62 +/- 0.13 mg/ mL (123% +/- 17%; P < 0.05; n = 6) at the end of the repeated albumin infus ions in the experimental group, whereas it did not change in the control gr oup. CRP level did not change in either group. The results of this study in dicate that hypoalbuminemia increases platelet aggregability. The observati on that the albumin infusion was not associated with changes in D-dimer and vWF despite the inverse correlations suggests that these relationships may be secondary to other factors, such as inflammation. (C) 1999 by the Natio nal Kidney Foundation, Inc.