Evaluation of coagulation and fibrinolysis in haemodialysis patients at different haematocrit levels: Comparison between patients with and without diabetes

SUMMARY: There is an insufficient number of reports concerning the optimal haematocrit level for haemodialysis patients with diabetes. Although many reports have indicated that recombinant human erythropoietin (rHuEPO) therapy does not influence the incidence of intravascular thrombosis, no study has focused its attention on the difference of the coagulation-fibrinolysis system between haemodialysis patients with and without diabetes. We studied eight patients with diabetes and seven patients without diabetes who had been undergoing regular haemodialysis. In all 15 patients, rHuEPO administration was started at a haematocrit level of 20% and toe haematocrit tevels were gradually increased from 20 to 30%. Coagulation and fibrinolysis functions, measured at haematocrit levels of 20,25 and 30%, respectively, were compared between the two groups. In the diabetic group, platelet count, fibrinogen, thrombin-antithrombin III complex, frtmn/fibrinogen degradation products = D dimer, platelet factor 4 and platelet adhesion were statistically higher (P < 0.05), and plasminogen and α2-plasmin inhibitor was statistically lower (P < 0.05) than those in the non-diabetic group, even at the 20% level. These abnormalities at the baseline were extremely enhanced in connection with haematocrit increased by rHuEPO. the diabetic group, in particular, showed greater increases of platelet factor 4, platelet adhesion and thrombomodulin and a decrease of α2-plasmin inhibitor from the 20% to the 30% level (P < 0.05) than the non-diabetic group. These findings suggest that haemodialysis patients with diabetes generally have enhanced thrombotic parameters compared with haemodialysis patients without diabetes, and the increase of haematocrit makes the difference greater. Accordingly, the target level of haematocrit for patients with diabetes should be set separately from that of patients without diabetes.