SERUM LEVEL OF VASCULAR CELL ADHESION MOLECULE AND P SELECTIN AS THROMBOPHILIC RISK FACTOR FOR EARLY VASCULAR ACCESS THROMBOTIC OCCLUSION IN HEMODIALYSIS PATIENTS

Abstract

Hemodialysis (HD) vascular access (VA) failure is the dominant cause of morbidity and the major cost of care for ESRD patients. The aim of the present work is to assess the serum level of vascular cell adhesion molecule and P- selectin in HD patients as markers for early thrombotic VA event. 90 CKD patients divided into three groups: group I: 10 subjects apparently health, group II: 10 Patients with CKD stage IV-V on medical treatment and group III: 70 Patients with CKD stage V on HD with recent VA insertion divided into 2 subgroups: Subgroup III a: 57 patients with AV shunt and subgroup III b: 13 patients with permanent catheter. Laboratory investigations done (blood urea, serum creatinine, eGFR, CBC, PT, and INR), imaging and serum VCAM 1, P selectin before and 6 months after HD There was positive connection between VCAM and P selectin and dialysis with statistics in form of p value (<0.001). Markers level pre dialysis and after 6 months of dialysis revealed that range of p selectin and VCAM1 level after 6 months are higher than pre dialysis level. Detection of elevated serum level of circulating sVCAM-1 and s P-selectin could be useful in the prediction of native AVF and permanent catheter thrombosis in chronic HD patients. The association between sVCAM-1 and s P-selectin and thrombosis in HD patients increases the evidence of the role of adhesion molecules in VA thrombosis