ABSTRACT
Objective: haemostatic defect is more common and consistent in occurrence during the progression of renal failure to end - stage renal disease [ESRD]. Although coagulopathy is complex in pathogenesis, a defect in3- brinolytic process plays a critical role in its development
Aim of the work: was to evaluate the fibrinolytic state in end stage renal disease [ESRDI patients before and after Haemodialysis [HD] using tissue plasminogen activator [t-PA] and plasminogen activator inhibitdr-1 [PAI-1] as fibrinolytic activity markers and to evaluate the possible contribution of AVF on fibrinolytic system
Subjects and Methods: this study was carried out on 14 end stage renal disease patients [8 males and 6 females] with age ranging from 30- 65 years [4 7.14 +/- 12.38 years], selected from haemodialysis unit of nephrology, Benha Teaching Hospital. Ten healthy normal volunteers oj matched age and sex were chosen as a control group. TPA and PAI-1 were measured before and after HD from contralateral reins and from venous return of arteriovenous fistula [AVV and from peripheral veins of the control group by ELISA
Results: the results revealed that there were significant' increase in t-PA with significant decrease in PAl-1 in contralateral veins and AVF before HD in ESRD patients when compared to controls. There were significant increase in t-PA with insignificant increase in PAI-l in conmlatera1 veins and AVF after HD when compared to before HD. On the other hand, there were decrease in t-PA [insignificant before HD bur significant after HD] with insignificant increase in PAI-1 [before and after HDI in AVF when compared to contralateral veins
In conclusion: fibrinolysis is enhanced in ESRD patients and further aggravated after HD. Impairment of fibrinolysis tic activity in AVF might lead to fistula thrombotic tendency during haemodidysis