Estudo de biomarcadores de trombose do acesso vascular em pacientes sob hemodiálise

Abstract

Hemodialysis is a kind of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients in the end stage renal disease. Vascular access complications constitute about 20-25% of all hospitalizations in dialysed patients. The occurrence of thrombosis in the vascular access is a serious problem that might severely compromise or even make impossible the hemodyalisis, which is vital for the patient. The aim of this study wasto investigate molecular, hemostatic and inflammatory alterations and of the ABO blood group frequency in patients undergoing hemodialysis as well as the association between these alterations and the occurrence of vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated, of which 149 patients had not experienced vascular access thrombosis (Group I) and 46 patients had this complication (Group II), beyond 80 healthy individuals (Group III). Mutations of prothrombin (G20210A) and factor V (G1691A) genes, D-Di, PAI-1, FvW, F VIII, ADAMTS-13, PCRus, IL-8 and TGF-b1 plasma levels, and ABO blood group have been investigated. Statistical analysis showed that D-Di, FvW and F VIII were increased, whereas PAI-1 and ADAMTS-13 were reduced in groups I and II if compared to group III. There was no difference between groups I and II in relation to the hemostatic and inflammatory parameters. ABO blood group frequency was similar in the three groups. The FvW plasma levels and F VIII activity was elevated in non O blood group individuals if compared to O blood group in all three studied groups. Prothrombin mutation (G20210A) had a significant and independent association with vascular access thrombosis. Factor V mutation (F V Leiden), hemostatic and plasma levels of inflammatory markers as well as the ABO blood group were not associated with this complication. There was a significant correlation between hemostatic and inflammatory markers in both groups of patients undergoinghemodialysis. Although the hemostatic and inflammatory markers evaluated have not shown to be useful in predicting the occurrence of vascular access thrombotic complications, the results of this study revealed that the patients undergoing hemodialysis present a hypercoagulability status. Furthermore, the results suggestedthe presence of prothrombin mutation (G20210A) is associated with the occurrence of vascular access thrombosis.