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Thromb Haemost 1990; 63(03): 356-360
DOI: 10.1055/s-0038-1645046
Original Article
Schattauer GmbH Stuttgart

Relation of Intraperitoneal and Intravascular Coagulation and Fibrinolysis Related Antigens in Peritoneal Dialysis

E Gries
The Medical Laboratory Dr. Gries, Munich, FRG
,
J Kopp
*   VIth Department of Medicine, Städtisches Krankenhaus M.-Schwabing, Munich, FRG
,
U Thomae
*   VIth Department of Medicine, Städtisches Krankenhaus M.-Schwabing, Munich, FRG
,
H Kuhlmann
*   VIth Department of Medicine, Städtisches Krankenhaus M.-Schwabing, Munich, FRG
› Author Affiliations
Further Information

Publication History

Received 26 September 1989

Accepted after revision 23 January 1990

Publication Date:
30 June 2018 (online)

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Summary

Patients received 2,000 ml of dialysate intraperitoneally with five exchanges per day during continuous peritoneal dialysis (CAPD) for the treatment of terminal renal insufficiency. During a dwell time of 4 h the dialysate reached a total protein concentration up to 100 mg/dl by mass transfer of intravascular proteins. The composition is dependent on the molecular weight of the proteins. This results in an intraperitoneal hemostatic system of low concentration and different composition.

We found an intraperitoneal fibrinogen cleavage and thrombin- antithrombin Ill-complex formation leading to increased levels of fibrinopeptide A (FPA: 33.3 ± 7.0 ng/ml) and thrombin-antithrombin Ill-complex (TAT: 4.7 ± 0.4 ng/ml) in plasma by mass transfer from dialysate to plasma. t-PA (tissue plasminogen activator) and PAI-1 (plasminogen activator inhibitor type 1) concentrations in plasma were within the normal range. The dialysate concentrations indicated a low local secretion. The fibrinolytic fibrin fragment D-dimer and the fibrinogen degradation product concentrations in plasma were greater than in dialysate. But the relations of the proteins between plasma and dialysate refer to a local intraperitoneal production as well.

The results show that intraperitoneal coagulation predominates over fibrinolysis which is accompanied by an intravascular fibrinolysis in patients undergoing CAPD. Neoantigens produced in dialysate and diffused to plasma are comparable to changes seen in disseminated intravascular coagulation.

 

  • References

  • 1 Felgenhauer K. Protein filtration and secretion at human body barriers. Pflügers Arch 1980; 384: 9-17
    CrossrefPubMedGoogle Scholar
  • 2 Nakamura RM, Spiegelberg HL, Lee S, Weigle WO. Relationship between molecular size and intra- and extravascular distribution of protein antigens. J Immunol 1968; 100: 376-83
    PubMedGoogle Scholar
  • 3 Reiber H. The discrimination between different blood-CSF barrier dysfunctions and inflammatory reactions of the CNS by a recent evaluation graph for the protein profile of cerebrospinal fluid. J Neurol 1980; 224: 89-99
    CrossrefPubMedGoogle Scholar
  • 4 Henderson JM, Stein SF, Kutner M, Wiles MB, Ausley JD, Rudman D. Analysis of twenty-three plasma proteins in ascites. Ann Surg 1980; 192: 738-42
    CrossrefPubMedGoogle Scholar
  • 5 Schölmerich J, Zimmermann U, Köttgen E, Volk BA, Ehlers S, Gerok W. Proteases and antiproteases related to the coagulation system in plasma and ascites - An approach to differentiate between malignant and cirrhotic ascites. Klin Wschr 1987; 65: 634-8
    CrossrefPubMedGoogle Scholar
  • 6 Felgenhauer K. Protein size and cerebrospinal fluid composition. Klin Wschr 1974; 52: 1158-64
    CrossrefPubMedGoogle Scholar
  • 7 Krediet RT, Zuyderhoudt FM J, Boeschoten EW, Arisz L. Peritoneal permeability to proteins in diabetic and non-diabetic continous ambulatory peritoneal dialysis patients. Nephron 1986; 42: 133-40
    CrossrefPubMedGoogle Scholar
  • 8 Schoppe W-D, Dirks E, Schnurr E, Kindler U. Proteinverlust bei Peritonealdialysen. Verh Dtsch Ges Inn Med 1976; 82: 1565-8
    PubMedGoogle Scholar
  • 9 Flessner MF, Dedrick RL, Schultz JS. Exchange of macromolecules between peritoneal cavity and plasma. Am J Physiol 1985; 248: H15-H25
    PubMedGoogle Scholar
  • 10 Gries E, Paar D, Graben N, Bock KD. Intrapcritoncal fibrin-formation and its inhibition in CAPD. Clin Nephr 1986; 26: 209-12
    PubMedGoogle Scholar
  • 11 Nolph KD, Lindblad AS, Novak JW. Continous ambulatory peritoneal dialysis. N Engl J Med 1988; 318: 1595-600
    CrossrefPubMedGoogle Scholar
  • 12 Thomae U, Herrmann M, Büchele W, Bockreis N. Hämodialyse und Peritonealdialyse bei niercninsuffizienten Typ-I-Diabetikern im Ver-gleich. Nieren- und Hochdruckkrankheiten 1988; 17: 96-101
    PubMedGoogle Scholar
  • 13 Rubin J, McFarland S, Hellems EW, Bower JD. Peritoneal dialysis during peritonitis. Kidney Int 1981; 19: 460-4
    CrossrefPubMedGoogle Scholar
  • 14 Gilmour J, Tymiansky R, Pierratos A, Vas S, Kline M, Khanna R, Digenis G, Cuff F, Oreopoulos DG. Changes in serum inflammatory proteins during peritonitis in CAPD patients. Perit Dial Bull 1983; 3: 201-4
    PubMedGoogle Scholar
  • 15 Gries E, Paar D, Graben N, Bock KD. Intraperitoneal heparin in peritoneal dialysis and its effect on fibrinopeptide A in plasma and dialysate. Haemostasis 1989; 1: 21-5
    PubMedGoogle Scholar
  • 16 Hau T, Simmons RL. Heparin in the treatment of experimental peritonitis. Ann Surg 1978; 178: 294-8
    PubMedGoogle Scholar
  • 17 Chalkiadakis G, Kostakis A, Karayannacos PE, Giamarellou H, Dontas J, Sakellariou J, Skalkeas GD. The effect of heparin upon fibrinopurulent peritonitis in rats. Surg Gynecol Obstet 1983; 157: 257-60
    PubMedGoogle Scholar
  • 18 O’Leary JP, Malik FS, Donahoe RR, Johnston AD. The effects of a minidose of heparin on peritonitis in rats. Surg Gynecol Obstet 1979; 148: 571-5
    PubMedGoogle Scholar
  • 19 Bertoli M, Gasparotto ML, Vertolli U, Ruffatti A, DiLandro D, Romagnoli GF. Does hypercoagulability exist in CAPD patients?. Perit Dial Bull 1984; 4: 237-9
    PubMedGoogle Scholar
  • 20 Anderson M, Mattews KB, Stuart J. Coagulation and fibrinolytic activity of cerebrospinal fluid. J Clin Pathol 1978; 31: 488-92
    CrossrefPubMedGoogle Scholar
  • 21 Hain H, Jörres A, Kögel B, Mahiout A, Gahl GM, Kessel M. Prostaglandin E2, Thromboxane B2, and Leukotriene B4 Release from Peritoneal Macrophages by Different Osmotic Agents in Nonuremic Guinea Pigs. Trans Am Soc Artif Intern Organs 1988; 34: 429-31
    PubMedGoogle Scholar
  • 22 Benz JJ. Clotting factors and fibrinogen split products in the extravascular space. Thromb Diath Haemorrh 1968; 19: 226-35
    PubMedGoogle Scholar
  • 23 Klaubertz W, Klaubert E, Hafter R, Bushe CH, Gollwitzer R, Graeff H. Fibronectin und Gerinnungsproteine in Plasma und Aszites von Patienten mit Leberzirrhose oder Karzinom. DHB Saarbriicken 1985; 367-9
    PubMedGoogle Scholar
  • 24 Steinhauer HB, Schollmeyer P. Prostaglandin-mediated loss of proteins during peritonitis in continuous ambulatory peritoneal dialysis. Kidney Int 1986; 29: 584-90
    CrossrefPubMedGoogle Scholar
  • 25 Gordon S, Unkeless JC, Cohn ZA. Induction of macrophage plasminogen activator by endotoxin stimulation and phagocytosis. J Exp Med 1974; 140: 995-1010
    CrossrefPubMedGoogle Scholar
  • 26 Porter JM, McGregor FH, Mullen DC, Silver D. Fibrinolytic activity of mesothelial surfaces. Surg Forum 1969; 20: 80-2
    PubMedGoogle Scholar
  • 27 Benzer H, Blümel B, Piza F. Über Zusammenhänge zwischen Fibrinolyse und intraperitonealen Adhäsionen. Wiener Klin Wschr 1963; 75: 881-3
    PubMedGoogle Scholar
  • 28 Vassalli JD, Hamilton J, Reich E. Macrophage plasminogen activator: modulation of enzyme production by anti-inflammatory steroids, mitotic inhibitors, and cyclic nucleotides. Cell 1976; 8: 271-81
    CrossrefPubMedGoogle Scholar
  • 29 Wilner GD, Chatpar P, Te A, Horowitz J. Effects of extravascular clotting on fibrinopeptide A levels in blood. J Lab Clin Med 1978; 91: 205-13
    PubMedGoogle Scholar
  • 30 Lane DA, Ireland H, Knight J, Wolff S, Kyle P, Curtis JR. The significance of fibrinogen derivates in palsma in human renal failure. Br J Haematol 1984; 56: 251-60
    CrossrefPubMedGoogle Scholar
  • 31 van der Meulen J, Beelen RH J, Oe PL, Verbrugh H, Hoefsmit EC M, Verhoef J. CAPD, a permanent state of peritonitis?. Perit Dial Bull 1984; (Suppl. 04) 68
    PubMedGoogle Scholar
  • 32 Gordge MP, Faint RW, Rylance PB, Ireland H, Lane DA, Neild GH. Plasma D-dimer: a useful marker of fibrin breakdown in renal failure. Thromb Haemostas 1989; 61: 522-5
    PubMedGoogle Scholar
  • 33 Trompke R, Sasse E. Das Schicksal des Rinderfibrinschaumes in der Bauchhöhle (tierexperimentelle Untersuchungen). Arch Klin Chir 1956; 281: 333-41
    PubMedGoogle Scholar
  • 34 Ahrenholz DH, Simmons RL. Fibrin in peritonitis. I. Beneficial and adverse effects of fibrin in experimental E. coli peritonitis. Surgery 1980 88. 41-7
    PubMedGoogle Scholar
  • 35 Speiser W, Anders E, Preissner KT, Wagner O, Miiller-Berghaus G. Differences in coagulant and fibrinolytic activities of cultured human endothelial cells derived from omental tissue microvessels and umbilical Veins. Blood 1987; 69: 964-7
    PubMedGoogle Scholar
  • 36 Musso R, Longo A, Cacciola RR, Lombardo A, Giustolisi R, Cacciola E. Elevated fibronectin plasma levels in diabetes mellitus are expression of increased synthesis and release by vascular endothelium. Thromb Haemostas 1989; 61: 150-1
    PubMedGoogle Scholar
  • 37 Solerte SB, Fioravanti M, Ferrari E. Plasma fibronectin as an indicator of microvascular damage in diabetic patients. Rapid and sensitive evaluation by a radial immunodiffusion technique. Ric Clin Lab 1987 17. 251-8
    PubMedGoogle Scholar
  • 38 Cembrowski GS, Mosher DF. Plasma fibronectin concentration in patients with acquired consumptive coagulopathies. Thromb Res 1984; 36: 437-42
    CrossrefPubMedGoogle Scholar