Abstract
PurposeTraditional anticoagulants used in intermittent hemodialysis (HD) are unfractionated heparin (UFH) and increasingly low molecular weight heparins (LMWHs). Repeated and prolonged exposure to UFH and/or LMWHs may further disturb hemostasis in uremic patients. Vascular adhesion protein-1 (VAP-1) is secreted by vascular smooth muscle cells, adipocytes and endothelial cells with functional monoamine oxidase activity and is elevated in atherosclerosis, diabetes mellitus and obesity. The aim of this study was to assess the effects of UFH and LMWHs on VAP-1 concentration in HD patients. The effects on single HD session on VAP-1 were also evaluated as well as VAP-1 levels in regard to type of renal replacement therapy.MethodsWe studied 82 hemodialyzed patients (mean age 63 years, dialysis vintage 59 months) and 17 patients treated by means of hemodiafiltration (HDF) (mean age 59 years, HD vintage 84 months, HDF 7 months). Patients were anticoagulated with enoxaparin (n = 46), dalteparin (n = 10), nadroparin (n = 6) or UFH (n = 20) during their HD sessions. VAP-1 was assessed using kits from BioVendor, Modrice, Czech Republic.ResultsPatients on HDF had significantly lower VAP-1 when compared with HD patients. We found that VAP-1 concentration in patients dialyzed by using LMWH or UFH was similar. There was no effect on HD session on VAP-1 concentration. Diabetic patients had higher serum VAP-1 than non-diabetic.ConclusionsHDF is associated with lower VAP-1 levels indicating less pronounced endothelial cell injury than hemodialysis. Type of heparin seems to have no effect on VAP-1 levels in hemodialyzed patients. However, the cross-sectional but not prospective design is a limitation of this study.
Highlights
Vascular adhesion protein-1 (VAP-1) is a copper-containing semi-carbazide-sensitive amine oxidase (SSAO) secreted by vascular smooth muscle cells, adipocytes and endothelial cells with functional monoamine oxidase activity [1]
HDF is associated with lower VAP-1 levels indicating less pronounced endothelial cell injury than hemodialysis
We found that VAP-1 concentration in patients dialyzed by using enoxaparin, fraxiparine, dalteparin or unfractionated heparin (UFH) was similar (Fig. 1)
Summary
Vascular adhesion protein-1 (VAP-1) is a copper-containing semi-carbazide-sensitive amine oxidase (SSAO) secreted by vascular smooth muscle cells, adipocytes and endothelial cells with functional monoamine oxidase activity [1]. Endothelial VAP-1 can act as an adhesion molecule [2] and is involved in leukocyte rolling, adhesion and transmigration, which are central steps during leukocyte extravasation to sites of inflammation, such as atherosclerotic lesions [3]. Hemodiafiltration (HDF) is a combination of convective and diffusive processes for solute removal, i.e., a combination of intermittent hemofiltration with simultaneous hemodialysis. Convection favors the elimination of higher molecular weight substances, whereas low molecular weight substances are removed from the blood by diffusion. Klingel et al [4] have reported that HDF in comparison with high-flux HD was associated with increased procoagulant activity in the extracorporeal circuit. We have shown previously that patients on HD showed evidence of a higher degree of endothelial
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
