Summary
Patients received 2,000 ml of dialysate intraperitoneally with five exchanges per
day during continuous peritoneal dialysis (CAPD) for the treatment of terminal renal
insufficiency. During a dwell time of 4 h the dialysate reached a total protein concentration
up to 100 mg/dl by mass transfer of intravascular proteins. The composition is dependent
on the molecular weight of the proteins. This results in an intraperitoneal hemostatic
system of low concentration and different composition.
We found an intraperitoneal fibrinogen cleavage and thrombin- antithrombin Ill-complex
formation leading to increased levels of fibrinopeptide A (FPA: 33.3 ± 7.0 ng/ml)
and thrombin-antithrombin Ill-complex (TAT: 4.7 ± 0.4 ng/ml) in plasma by mass transfer
from dialysate to plasma. t-PA (tissue plasminogen activator) and PAI-1 (plasminogen
activator inhibitor type 1) concentrations in plasma were within the normal range.
The dialysate concentrations indicated a low local secretion. The fibrinolytic fibrin
fragment D-dimer and the fibrinogen degradation product concentrations in plasma were
greater than in dialysate. But the relations of the proteins between plasma and dialysate
refer to a local intraperitoneal production as well.
The results show that intraperitoneal coagulation predominates over fibrinolysis which
is accompanied by an intravascular fibrinolysis in patients undergoing CAPD. Neoantigens
produced in dialysate and diffused to plasma are comparable to changes seen in disseminated
intravascular coagulation.
