Comparison of hemostatic disturbances between patients on CAPD and patients on hemodialysis

Objective: Disturbances in hemostasis are common findings in uremic patient s. Both bleeding diathesis and thrombosis are observed. The purpose of this study was to assess whether renal replacement therapy in the form of hemod ialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) affects co agulation and fibrinolysis in patients with end-stage renal failure. Design: Comparison of hemostatic measures in patients on CAPD, HD, and matc hed healthy controls. Setting: Department of Nephrology and Internal Medicine, Bialystok Universi ty School of Medicine. Patients and Methods: Twenty-four HD patients and 23 CAPD patients were eva luated with respect to platelet aggregation, hemostatic parameters, serum l ipids, lipoprotein(a), and cytokines [tumor necrosis factor alpha (TNF alph a) and interleukin-1 (IL-1)]. Interventions: Four exchanges of CAPD per day, using 2.0 L dialysate over a period of 25 +/- 31 months; or 4-5 hours of HD 3 times per week for a peri od of 31 +/- 22 months. Results: Platelet aggregation in whole blood and platelet-rich plasma was s ignificantly impaired in both groups of dialyzed patients compared to healt hy volunteers. Markers of endothelial cell injury (thrombomodulin and von W illebrand factor) were significantly higher in HD and CAPD patients compare d to the control group. A similar pattern of changes was observed for lipop rotein(a), fibrinogen, tissue factor pathway activity, and factor VII activ ity Activity of factor X was significantly enhanced in CAPD compared to HD patients and controls. Euglobulin clot lysis time was significantly prolong ed in HD and CAPD patients over controls, being more prolonged in CAPD pati ents. Markers of ongoing coagulation (thrombin-antithrombin complexes and p rothrombin fragments 1+2) were higher in uremic patients, significantly hig her in CAPD than in HD. A marker of ongoing fibrinolysis (plasmin-antiplasm in complexes) was higher in uremic patients but was lower in CAPD than in H D patients. Concentrations of TNF alpha and IL-1 were higher in HD than in CAPD patients. Conclusion: Patients on CAPD showed evidence of a higher degree of hypercoa gulation than HD patients. Thus, hemostatic abnormalities in end-stage rena l failure may be affected to some extent by the choice of renal replacement therapy.