DOES THE CHOICE OF RENAL REPLACEMENT THERAPY ADVERSELY AFFECT THE HYPERCOAGULABILITY ASSOCIATED WITH RENAL-DISEASE

Both a bleeding diathesis and a tendency to hypercoagulability occur i n the course of renal disease. More common and consistent in occurrenc e during the progression of renal failure to end-stage renal disease i s the hemostatic defect. The principal cause of this abnormality is th e uremic state and, as a rule, it is reversible following the institut ion of adequate renal replacement therapy and correction of the anemia with epoietin. By contrast, the tendency to hypercoagulability is usu ally encountered in patients with the nephrotic syndrome and shows a c orrelation to the degree of hypoalbuminemia, being more evident at ser um albumin levels of < 2 g/dl. Although the coagulopathy is complex in pathogenesis, a defect in the fibrinolytic process plays a critical r ole in its development. A tendency to pro-thrombosis due to abnormal f ibrinolysis has been identified also in patients on renal replacement therapy with continuous ambulatory peritoneal dialysis (CAPD). The obs erved coagulation abnormalities resemble those of the nephrotic syndro me. Although its etiology remains undefined, a role for the albumin lo sses in the peritoneal dialysate has been implicated in the prothrombo tic state that occurs in some CAPD patients.