Changes in peritoneal coagulation and fibrinolysis after discontinuation of chronic peritoneal dialysis

Abstract

Objectives: To study changes in peritoneal function after transfer from chronic peritoneal dialysis (CPD) to hemodialysis (HD), especially the effects on peritoneal coagulation, fibrinolytic markers, and mesothelium. Design: Prospective observational study. Setting: A tertiary-care university hospital. Patients: Nine patients who transferred from CPD to HD were enrolled in the study after giving fully informed consent. Methods: After transfer to HD, the peritoneal cavity was lavaged with low glucose PD solution once per day through PD catheters left in place. Thrombin-antithrombin III complex (TAT) was measured serially as a marker of peritoneal coagulation. As fibrinolytic markers, fibrinogen/fibrin degradation products (FDP) and plasmin-α2-antiplasmin complex (PIC) were assessed. Cancer antigen 125 (CA125) was measured as a marker of mesothelial cell mass. Results: Levels of peritoneal TAT and FDP were much higher than plasma levels, indicating high local fibrin turnover. Transfer to HD induced a significant fall in mean peritoneal TAT, from 115.8 ± 52.1 to 60.7 ± 21.8 ng/mL, p < 0.05. Except for 1 patient with a 20-fold increase, mean peritoneal FDP decreased significantly, from 43.6 ± 11.1 to 19.6 ± 3.5 μg/mL, p < 0.05. Mean peritoneal PIC increased significantly, from 1.9 ± 0.4 to 3.9 ± 0.6 μg/mL, p < 0.05. Peritoneal CA125 increased from 156.4 ± 57.3 to 1426.2 ± 389.4 U/mL, p < 0.05. Conclusions: Peritoneal fibrin turnover was accelerated on CPD and stabilized after transfer to HD. Transfer to HD also induced mesothelial regeneration.