Platelet hyperreactivity in hemodialysis patients with frequently occluded vascular access

Kang-Ju Chou; Chung-Ren Jan; Po-Tsang Lee; Chien-Liang Chen; Hsiao-Min Chung; Yueh-Yen Hwang; Jing-Dung Chou; Hua-Chang Fang

doi:10.1160/TH04-01-0048

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2004; 92(03): 621-626
DOI: 10.1160/TH04-01-0048

Platelets and Blood Cells

Schattauer GmbH

Platelet hyperreactivity in hemodialysis patients with frequently occluded vascular access

Kang-Ju Chou

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

²National Yang-Ming University, School of Medicine, Taipei, Taiwan

,

Chung-Ren Jan

³Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung Taiwan

,

Po-Tsang Lee

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

²National Yang-Ming University, School of Medicine, Taipei, Taiwan

,

Chien-Liang Chen

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

²National Yang-Ming University, School of Medicine, Taipei, Taiwan

,

Hsiao-Min Chung

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

²National Yang-Ming University, School of Medicine, Taipei, Taiwan

,

Yueh-Yen Hwang

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

,

Jing-Dung Chou

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

,

Hua-Chang Fang

¹Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

²National Yang-Ming University, School of Medicine, Taipei, Taiwan

› Institutsangaben

Abstract

Summary

It is known that thrombosis is a leading cause of vascular access failure and that the formation of thrombus requires platelets. The activation of platelets induces the increase in intracellular Ca²⁺ levels ([Ca²⁺]_i) leading to aggregation and thrombosis. We compared the platelet [Ca²⁺]_i before and after stimulation between the patients with and without easily occluded vascular access. Our study included two groups of hemodialysis patients. Group 1 consisted of 21 patients who had received chronic hemodialysis therapy for more than 6 months. They had had more than three events (including three) of vascular access failures during the past year. Group 2 consisted of 21 hemodialysis patients with age, sex, and diabetes mellitus matched who had never suffered from any event of vascular access failure. We measured the basal and stimulated platelet [Ca²⁺]_i after stimulation with 1 U/ml thrombin, 1 µM arachidonic acid, 1 µM platelet activation factor (PAF), and 10 µM adenosine diphosphate (ADP), respectively. Our results showed that in Ca²⁺-containing media, there was no significant differences in the basal [Ca²⁺]_i _, but the maximal increases of [Ca²⁺]_i of platelets were higher (p <0.05) in group 1 than in group 2 after stimulating with PAF and ADP, but not with thrombin and arachidonic acid. We concluded that the causes for the susceptibility of some hemodialysis patients to vascular access occlusion were multifactorial. In addition to previously reported plasma factors, there was a subgroup of patients who showed greater elevations of agonists stimulated platelet intracellular calcium levels.

Keywords

Agonists - hemodialysis - intracellular calcium - platelet - vascular access failure

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Referenzen

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