The Role of Hemostatic Factors in Atherosclerosis in Patients with Chronic Renal Disease
Keywords:
Chronic kidney disease (CKD), hemodialysis (HD), atherosclerosis, carotid intima media thickness (CIMT), TM, vWf, t-PA, PAI-1Abstract
Introduction: Atherosclerotic cardiovascular disease remains the leading cause of increased morbidity and mortality observed in chronic kidney disease (CKD) patients. Endothelial dysfunction (ED) is thought to be a key initial event in the development of atherosclerosis. The aim of this study was to evaluate the potential role of hemostatic factors in atherosclerosis, thrombosis and cardiovascular complications in patients suffering from chronic renal disease.
Methods: The study was conducted on 50 renal patients divided into two groups of equal size. Group 1 consisted of 25 patients with end-stage renal disease (ESRD) on regular hemodialysis. Group 2 consisted of 25 chronic renal disease patients on conservative treatment. Twenty age- and sex-matched healthy subjects were included in the study to serve as a control group. Thrombomodulin (TM), von Willebrand factor (vWF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) and hsCRP were assessed. High-resolution B-mode ultrasonography of both the common and internal carotid arteries to measure carotid intima media thickness (CIMT) was performed on all subjects.
Results: There were highly significant increases in hsCRP, TM, vWF, tPA and PAI-1 in both patient groups compared to the control group (P<0.01 for all except for TM between group 2 and 3 P<0.05) with significant increase in group 1 compared to group 2 (P<0.01). In addition, there was a highly significant increase in CIMT in both patient groups compared to the control group (P<0.01) with a significant increase in group 1 compared to group 2 (P<0.05). The study revealed significant positive correlation of hemostatic factors (TM, vWf, PAI-1 & t-PA) with creatinine, urea, hsCRP & CIMT.
Conclusion: CKD patients have increased risk of atherosclerosis as measured by CIMT, which is used as a surrogate marker of early atherosclerosis and has been shown to be a strong predictor of future myocardial infarction and stroke. They have high levels of TM, vWF, tPA, PAI-1 that correlate with kidney function, hsCRP and CIMT. Therefore, these abnormalities in hemostasis may account for the increased risk of atherothrombosis in these patients. The elevated hsCRP levels and their correlation to hemostatic factors and CIMT might provide an important clue to link a systemic marker of inflammation to atherosclerosis. Further research is required to better understand the procoagulant state in patients with CKD.
References
Smith M J. Cardiovascular complications in chronic kidney disease. Am J Kidney Dis. 2003; 41(5):11–7.
Jalal D, Chonchol M,Targher G. Disorders of hemostasis associated with chronic kidney disease. Semen
Thromb Hemostat. 2010; 36(1):34-40. Doi: 10.1055/s-0030-1248722, PMid: 20391294
Péquériaux NC, Fijnheer R, Gemen EF, Barendrecht AD, Dekker FW, Krediet RT, Beutler JJ, Boeschoten
EW, Roest M.Plasma concentration of von Willebrand factor predicts mortality in patients on chronic renal
replacement therapy. Nephrol Dial Transplant. 2012;27(6):2452-7. doi: 10.1093/ndt/gfr735, PMid:
Polenaković M, Oncevski A, Sikole A, Dejanova B, Panov S, Kostovska S. The role of the von Willebrand
factor in renal diseases and haemodialysis patients. Prilozi. 2004; 25(1-2):5-15. PMid: 15735532
Spiel AO, Gilbert JC, Jilma B.Von Willebrand Factor in cardiovascular disease.focus on acute coronary
syndromes. Circulation. 2008; 117(11): 1449-59. Doi: 10.1161/CIRCULATIONAHA.107.722827, PMid:
Li YH, Kuo CH, Shi GY, Wu HL, The role of thrombomodulinlectin like domain in inflammation.
Jbiomedsci, 2012;19(1):34-6. Doi: 10.1186/1423-0127-19-34, PMid: 22449172, PMCid: PMC3342133
Yasar Yildiz S, Kuru P, ToksoyOner E, Agirbasli M. Functional stability of plasminogen activator
inhibitor-1. The scientific world journal, 2014. doi: 10.1155/2014/858293, PMid: 25386620, PMCid:
PMC4214104
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with
carotid intima-media thickness. A systematic review and meta-analysis. Circulation, 2007;115:459–67.
Doi: 10.1161/CIRCULATIONAHA.106.628875, PMid: 17242284
Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: A new tool for diagnosis
and treatment of cardiovascular risk. J Hypertens. 2002;20:159–69. Doi: 10.1097/00004872-200202000- 00001, PMid: 11821696
Zhang L, Zhao F, Yang Y, Qi L, Zhang B, Wang F, et al. Association between carotid artery intima-media
thickness and early-stage CKD in a Chinese population. Am J Kidney Dis. 2007;49:786–92. Doi:
1053/j.ajkd.2007.03.011, PMid: 17533021
Luke RG.Chronic renal failure – A vasculopathic state. New Engl J Med. 1998; 339(12): 841-3. Doi:
1056/NEJM199809173391211, PMid: 9738095
Juhan-Vague I, Collen D. On the role of coagulation and fibrinolysis inatherosclerosis. Ann Epidemiol.
;2(4):427-38. Doi: 10.1016/1047-2797(92)90092-5
Sonneveld MAH, VanDijk AC,,Vanden Herik EG .etal. Relationship of Von willebrandfactor with carotid
artery and aortic arch calcification in ischemic stroke patients. Atherosclerosis. 2013; 230(2):210–5. Doi:
1016/j.atherosclerosis.2013.07.046, PMid: 24075746
Kopeć G , Moertl D, Steiner S, Stępień E, Mikołajczyk T, Podolec J, Waligóra M, Stępniewski J,
Tomkiewicz-Pająk L, Guzik T, Podolec P. Markers of thrombogenesis and fibrinolysis and their relation to
inflammation and endothelial activation in patients with idiopathic pulmonary arterial hypertension.
PLoSONE. 2013;8(12):e82628. Doi: 10.1371/journal.pone.0082628, PMid: 24312667, PMCid:
PMC3847115
Gray RP, Yudkin JS, Patterson DLH. Plasminogen activator inhibitor: a risk factor for myocardial
infarction in diabetic subjects. Br Heart J. 1993; 69:228-32. Doi: 10.1136/hrt.69.3.228, PMid: 8461220,
PMCid: PMC1024985
Bono D. Significance of raised plasma concentrations of tissue-type plasminogen activator and
plasminogen activator inhibitor in patients at risk from ischaemic heart disease. Br Heart J, 1994; 71:504-7.
Doi: 10.1136/hrt.71.6.504, PMid: 8043326, PMCid: PMC1025439
Segarra A, Chacón P, Martinez-Eyarre C, Argelaguer X, Vila J, Ruiz P, Fort J, Bartolomé J, Camps J,
Moliner E, Pelegrí A, Marco F, Olmos A,Piera L. Circulating Levels of Plasminogen Activator Inhibitor
Type-1, Tissue Plasminogen Activator, and Thrombomodulin in Hemodialysis Patients:Biochemical
Correlations and Role as Independent Predictors of Coronary Artery Stenosis. J Am SocNephrol. 2001;
:1255-63. PMid: 11373350
Bao YS, Jia XB, Wang D, Liu RC, Zou CB, et al. Characterization of soluble thrombomodulin levels in
patients with stage 3-5 chronic kidney disease. Biomarkers, 2014; 19(4):275-80. Doi:
3109/1354750X.2014.904000, PMid: 24854597
Dubin R, Cushman M, Folsom AR, Fried LF, Palmas W, Peralta CA, Wassel C, Shlipak MG. Kidney
function and multiple hemostatic markers: cross sectional associations in the multi-ethnic study of
atherosclerosis. BMC Nephrology, 2011; 12:3, doi:10.1186/1471-2369-12-3.
Xin ZL, Dong XC, Juan M, Xin Z and Ren LP. Correlation between thrombomodulin and atherosclerosis
in chronic kidney diseases patients. Chinese journal of nephrology, 2011; 27(8): 581-4.
Olivot JM, Labreuche J, Aiach M,Amarenco P. Soluble thrombomodulin and brain infarction: case– control
and prospective study. Stroke, 2004; 35: 1946–51. Doi: 10.1161/01.STR.0000133340.37712.9b, PMid:
Dosa E, Ent L,Kolla L. C reactive protein, fibrinogen, soluble thrombomodulin and vascular disease.
Stroke, 2006; 36: 944-8.
Ishii H, Nakano M, Tsubouchi J, Ishikawa T, Uchiyama H, Hiraishi S, et al.Establishment of enzyme
immunoassay of human thrombomodulin inplasma and urine using monoclonal antibodies. Thromb
Haemost, 1990,63(2):157-62. PMid: 2163551
El-Banawy S, Emara F, Kandil MH, Khalil ES, Maharem D. Atherosclerosis in Hemodialysis Patients:
Relation to Chronic Inflammation and Endothelial Dysfunction. Journal of Medical Research Institute,
; 28 (2): 131-41.
Park AK, Jo MH, Han SJ, Kim JM, Kwun HD, et al. Features of atherosclerosis in hemodialysis patients
Kidney Res Clin Pract, 2013; 32: 177–82. Pract, 2013; 32: 177–82., doi: 10.1016/j.krcp.2013.10.002
Published
Issue
Section
License
Copyright (c) 2020 knowledge kingdom publishing
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.