Journal Article

Soluble thrombomodulin is associated with viral hepatitis, blood pressure, and medications in haemodialysis patients

Jacek Borawski, Beata Naumnik, Krystyna Pawlak and Michał Myśliwiec

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 16, issue 4, pages 787-792
Published in print April 2001 | ISSN: 0931-0509
Published online April 2001 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/16.4.787
Soluble thrombomodulin is associated with viral hepatitis, blood pressure, and medications in haemodialysis patients

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Background. The level of soluble thrombomodulin (sTM), a traditional marker of endothelial injury, is also dependent on renal excretory function. We studied serum sTM in chronic haemodialysis (HD) patients to determine which factors are predictive of its levels in this population.

Methods and results. sTM levels of 10.7 (5.72–30.7) ng/ml in 100 HD patients were higher than in 30 controls (P<0.0001). In a bivariate regression analysis, immunoreactive sTM was positively associated with the presence of hepatitis B virus surface antigen and/or anti‐hepatitis C virus antibodies measured by third generation ELISAs (P<0.0001), and was related to certain markers of liver injury and biosynthetic dysfunction. sTM was also directly associated with time on dialysis (P=0.001), or use of unfractionated heparin (UFH) (vs enoxaparin) (P=0.0007), erythropoietin (P=0.008), ACE‐inhibitors (P=0.034), acetate‐buffered dialysate (vs bicarbonate) (P=0.040), pre‐dialysis systolic (P=0.012), and diastolic blood pressure (P=0.043). It was negatively associated with lipoprotein(a) (P=0.029). sTM was not related to age, sex, smoking, cause of renal failure, prevalence of cardiovascular disease, amount of HD delivered, preserved residual renal function, ferritin, C‐reactive protein, and other vasoactive medications used. In a multivariable analysis, a positive hepatitis marker (P=0.0002), the use of UFH (P=0.030) and erythropoietin (P=0.019), and raised pre‐dialysis blood pressure (P=0.024) were positive independent predictors of high sTM level.

Conclusion. These data indicate that, in addition to endothelial activation, elevated sTM levels in HD patients may be related to viral infection and/or liver dysfunction, and influenced by modifiable factors such as increased blood pressure, and the type of heparin and erythropoietin treatment used.

Keywords: arterial blood pressure; erythropoietin; haemodialysis; heparin; soluble thrombomodulin; viral hepatitis

Journal Article.  4033 words.  Illustrated.

Subjects: Nephrology

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