Abstract
In order to clarify the effect of hemodialysis (HD) on the fibrinolytic system, fibrinolytic activity was evaluated in 27 patients undergoing regular hemodialysis treatment, using new parameters including alpha 2-plasmin inhibitor (α2PI), alpha 2-plasmin inhibitor-plasmin complex (α2PIC) and FDP-D dimer (D-dimer). α2PIC is regarded as a good parameter of in vivo plasmin production and D-dimer as a good one of fibrinolysis secondary to coagulation. Plasma antigen levels of α2PI and α2PIC were determined by the one step sandwitch EIA method. Plasma α2PI activity was measured by the specific tripeptide substrate method. Predialysis levels of α2PIC were significantly higher in reqular hemodialysis patients than in normal controls (p<0.01). During HD, α2PIC exhibited a continuous significant increase and reached up to about 180% of the starting values until the end of HD (p<0.001). α2PI activity was significantly decreased at the end of the HD (p<0.05). α2PI antigen was significantly reduced at 60 minutes after starting HD (p<0.05). D-dimer was significantly increased at 60 minutes and at the end of HD (both, p<0.05) and the peak values of D-dimer were obtained at 60 minutes. There were no significant changes in fibrinogen, plasminogen activity and AT III activity during HD. The findings of α2PI and α2PIC suggest that fibrinolytic activity is slightly increased in regular hemodialysis patients and is still more enhanced during HD. The increment in D-dimer during HD suggests that enhanced fibrinolysis during HD in partly related to fibrinolysis secondary to coagulation.
