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Heart 1999;81:134-140 ( February )
a Department of
Cardiological Sciences, St George's Hospital Medical School, Cranmer
Terrace, London SW17 0RE, UK, b Department of Renal Medicine, St George's
Hospital Medical School, London SW17 0RE, UK, c Department of Renal Medicine, St Helier
Hospital, Carshalton, Surrey SM5 1AA, UK
Correspondence to: Dr Al-Saady. email: nalsaady{at}sghms.ac.uk
Accepted for publication 16 September 1998
Objective
To
investigate the expression of monocyte tissue factor (MTF) and adhesion
molecules in patients with chronic renal failure (CRF) and to look for
any correlation with thrombin generation and Lp(a) lipoprotein.
DesignA study of MTF
expression and adhesion molecules, prothrombin fragments 1+2 (PTf1+2),
an index of thrombin generation, and lipoproteins in patients with CRF
and in normal control subjects.
BackgroundPatients
with end stage renal failure have an increased risk of coronary artery
disease despite advances in therapy. Stimulated monocytes are potent
activators of blood coagulation through the generation of MTF, which
was recently implicated in the aetiology of acute coronary ischaemic syndromes.
MethodsMTF expression
and adhesion molecules were measured in whole blood using
immunofluorescence of monocytes labelled with anti-tissue factor
antibody and CD11b and c by flow cytometry. PTf1+2 and Lp(a)
lipoprotein in plasma were measured by enzyme linked immunosorbent assay (ELISA).
Patients70 patients
with CRF without documented coronary artery disease (30 patients with
CRF undialysed, 20 patients undergoing chronic ambulatory peritoneal
dialysis (CAPD), and 20 undergoing haemodialysis (HD)), together with
20 normal controls, were studied.
ResultsThe
(mean (SD)) increased MTF of CRF (48.0 (29)
v 33.3 (7.2) mesf unit/100 monocytes in
controls, p = 0.04) was more pronounced in patients undergoing
dialysis (HD 73.1 (32.8) (p < 0.003) and CAPD 62.8 (28.9) mesf
unit/100 monocytes, p < 0.04). MTF activity showed a positive
correlation with both PTf1+2 and serum creatinine (p < 0.003) but
not with Lp(a) lipoprotein. Lp(a) lipoprotein was significantly
increased in both dialysis groups compared with controls (p < 0.005)
and non-dialysis CRF groups (p < 0.02). Monocyte adhesion molecule
(CD11b) was significantly higher in all three CRF groups than in the
controls (p = 0.006).
ConclusionThis
study has demonstrated a hypercoagulable state in patients with CRF.
This was especially pronounced in the dialysis patients. These findings
provide a possible explanation for the increased cardiovascular and
cerebrovascular morbidity and mortality in these patients.
This article has been cited by other articles:
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  N.C. Edwards, R.P. Steeds, C.J. Ferro, and J.N. Townend The treatment of coronary artery disease in patients with chronic kidney disease QJM, November 1, 2006; 99(11): 723 - 736. [Abstract] [Full Text] [PDF]
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 J. Borawski, B. Naumnik, and M. Mysliwiec Tissue Factor and Thrombomodulin in Hemodialysis Patients: Associations with Endothelial Injury, Liver Disease, and Erythropoietin Therapy Clinical and Applied Thrombosis/Hemostasis, October 1, 2002; 8(4): 359 - 367. [Abstract] [PDF]
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 B.-Q. Shen, D. Y. Lee, K. M. Cortopassi, L. A. Damico, and T. F. Zioncheck Vascular Endothelial Growth Factor KDR Receptor Signaling Potentiates Tumor Necrosis Factor-induced Tissue Factor Expression in Endothelial Cells J. Biol. Chem., February 9, 2001; 276(7): 5281 - 5286. [Abstract] [Full Text] [PDF]
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