Abstract:
BACKGROUND/AIMS:Patients with chronic renal failure (CRF) secondary to diabetes mellitus show a high incidence of atherosclerosis with its thrombotic complications. Both CRF and type 2 diabetes mellitus (DM2) results in fibrinolysis defects causally related to atherogenesis and thrombogenesis. It is not well known whether or not and, if so, how fibrinolysis is altered in patients with both CRF and DM2. Our study was designed (1) to identify the fibrinolysis defect present in patients with DM2-mediated CRF and treated by long-term hemodialysis (DM2HD), and (2) to establish whether the fibrinolysis defect is related to the metabolic abnormalities observed in CRF or DM2. METHODS:Sixteen DM2HD patients and 23 healthy individuals (HI) had their euglobulin clot lysis time (ECLT), and tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) activities (act) and concentrations (ag) assessed before and after standard fibrinolytic stimulus (i.v. administration of 0.4 microg/kg BW 1-deamino-8-D-arginine vasopressin, DDAVP) along with metabolic status markers. RESULTS:DDAVP caused a significant shortening of ECLT, rises in tPA act and ag, and a significant decrease in PAI-1 act. PAI-1 ag declined significantly in HI, but not in DM2HD. A comparison of responses to DDAVP revealed the groups differed significantly in the change in PAI-1 ag. Whereas, in HI, PAI-1 ag decreased by 11.8 ng/ml, no decrease was seen in DM2HD (0.0 ng/ml) (p < 0.0001; medians given; unpaired Wilcoxon's test). Stepwise regression analysis showed the change in PAI-1 ag was highly group-specific (DM2HD vs. HI, regression coefficient 21.22; partial correlation 0.58; p < 0.0001) and, also dependent on the serum concentrations of apolipoprotein A-I (-32.41; -0.46; p < 0.01) and homocysteine (0.35; 0.36; p < 0.05). CONCLUSIONS:Patients with type 2 DM and CRF on long-term hemodialysis have a fibrinolysis defect manifesting itself after standard fibrinolytic stimulus by an insufficient decrease in PAI-1 concentrations. The defect is related to decreased serum levels of apolipoprotein A-I and increased serum levels of homocysteine. The defect might be a factor contributing to accelerated atherosclerosis and thrombotic complications in these patients.
journal_name
Am J Nephroljournal_title
American journal of nephrologyauthors
Opatrný K Jr,Zemanová P,Mares J,Vít L,Opatrná S,Sefrna F,Hejda V,Tomsů M,Eiselt J,Massry SGdoi
10.1159/000065270subject
Has Abstractpub_date
2002-09-01 00:00:00pages
429-36issue
5-6eissn
0250-8095issn
1421-9670pii
65270journal_volume
22pub_type
杂志文章abstract::There is evidence to suggest that a renal embryogenesis disorder, with an associated deficit of nephrons, may be the cause of nephropathy later in the lives of patients with Balkan endemic nephropathy (BEN). This evidence includes the renal dysplasia or hypoplasia observed in BEN patients, the high incidence of renal ...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.1159/000063771
更新日期:2002-07-01 00:00:00
abstract::The purpose of our study was to investigate the feasibility of using lactate as a complete or partial substitute for acetate in hemodialysis solutions. Six patients, each serving as his own control, were dialyzed once against a dialysis solution containing 40 mM acetate, once against a dialysis solution containing 40 ...
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pub_type: 临床试验,杂志文章
doi:10.1159/000167515
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abstract::Most pretransplant malignancies require a tumor-free waiting period before transplantation. End-stage renal disease (ESRD) patients have an increased risk of renal cell carcinoma (RCC), which is mostly detected from routine screening during pre-kidney transplant evaluation. RCC must be quiescent prior to kidney transp...
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journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章
doi:10.1159/000046235
更新日期:2001-03-01 00:00:00
abstract::We have demonstrated considerable variability in the volumes of different glomeruli in given individuals (individual glomerular volume: IGV) in a stereologic study of kidneys at forensic autopsy performed to investigate sudden or unexpected death in people without manifest kidney disease. We review some important asso...
journal_title:American journal of nephrology
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pub_type: 杂志文章
doi:10.1159/000084275
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journal_title:American journal of nephrology
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abstract::Autopsy reports on 155 successive end-stage renal disease (ESRD) patients and 147 control patients without ESRD, matched for age, race and gender, were collected. Cystic transformation of the kidneys was noted in 58% of the ESRD patients and 13.6% of the control patients. There were 25 ESRD patients with renal adenoma...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167988
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journal_title:American journal of nephrology
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pub_type: 杂志文章
doi:10.1159/000151770
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abstract::Several medical inventors in Europe and North America brought the artificial kidney (hemodialysis) to practical usefulness in the late 1940s, but there were very few early successes. It was used at first for only desperate cases of acute renal failure. Renal authorities in the 'metabolic' tradition favored newly quant...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
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journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000487198
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pub_type: 杂志文章
doi:10.1159/000501058
更新日期:2019-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000370317
更新日期:2014-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章,评审
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更新日期:1990-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章,评审
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journal_title:American journal of nephrology
pub_type: 杂志文章
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更新日期:1995-01-01 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
doi:10.1159/000166711
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journal_title:American journal of nephrology
pub_type: 杂志文章,多中心研究
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更新日期:2017-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013391
更新日期:1998-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000119742
更新日期:2008-01-01 00:00:00
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journal_title:American journal of nephrology
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journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000256665
更新日期:2010-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章
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更新日期:2013-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000163592
更新日期:2009-01-01 00:00:00
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journal_title:American journal of nephrology
pub_type: 杂志文章,评审
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更新日期:1997-01-01 00:00:00