Some Hemostatic Changes During the Course of Hemodialysis in Patients with Erythropoietin Treatment

Abstract

The recombinant human erythropoietin (rHuEPO), an effective agent in the treatment of renal anemia, can predispose chronic uremic patients to thrombotic events with regular hemodialysis (HD). It has been proposed that increased release of tissue plasminogen activator (t-PA) from endothelial cells, together with consumption of plasminogen activator inhibitor-1 (PAI- 1), is likely to be a leading cause of enhanced fibrinolytic activity (FA) during HD. In our study, rHuEPO-treated patients manifested PAI-1 Ag (antigen) plasma levels that were significantly augmented after HD, suggesting FA inhibition during the HD session. The elevated predialysis beta-thromboglobulin (BTG) and platelet factor-4 (PF-4) plasma levels were increased in rHuEPO-treated patients during HD; the platelet protein levels were simultaneously decreased in the control group. Both findings reflect decreased FA and greater activity of platelets in the course of HD with administration of rHuEPO and a possible correlation of these mechanisms with the questioned prothrombotic performance of rHuEPO. Key Words: Erythropoietin—Hentodiatysts—Fibrinotytic activity—Platelet proteins.