Heritable and acquired thrombophilias and the risk for hemodialysis arteriovenous fistula thrombosis
Abstract
Background. Vascular access thrombosis is the most common complication in hemodialysis patients. The role of thrombophilia in access thrombosis is not established. Among the risk factors that have been proposed high blood concentrations of total homocysteine and hereditary gene mutations have been considered, but the findings available are controversial. The aim of the study was to compare serum level of homocysteine and genetic thrombosis risk factors (Leiden mutation, mutation G20210A and in gene MTHFR) in patients underwent one or more vascular access thrombosis in comparison to control group without thrombosis. A case-control study was conducted of 127 hemodialysis patients to determine whether thrombophilia was associated with arteriovenous fistula thrombosis. Patients were tested for factor V Leiden, prothrombin gene mutation, methylenetetrahydrofolate reductase genotype, serum homocysteine. It is shown that the total plasma homocysteine level in patients undergoing dialysis is differed from healthy subjects (27,5 ± 9,34 vs 11,2 ± 3,54 µmol/l, p < 0,05), but similar to those in control and experimental groups (28,3 ± 5,1 vs 25,8 ± 6,3 µmol/l). Frequencies of mutations in research and control groups were as follows: Leiden mutation - 4,7 and 3,5%; mutation MTHFR heterozygotic - 28,6 and 31,7%, MTHFR homozygous 2,4 and 3,5%; mutation MTHFR heterozygotic + Leiden mutation of 2,4 and 3,5%, respectively. The conclusion. System risk factors of a venous thrombosis, such as level of tHcy and mutations of genes, do not affect the frequency of thrombosis of vascular access in patients on maintenance hemodialysis. Large, multicenter, prospective cohort studies are needed to confirm the observations from this case-control retrospective study.
About the Authors
V. Yu. Shilo
Центр Диализа при ГКБ № 20
Russian Federation
Russian Federation
A. Yu. Denisov
Центр Диализа при ГКБ № 20
Russian Federation
Russian Federation
T. V. Kozlova
Московская медицинская академия им. И.М. Сеченова, г. Москва
Russian Federation
Russian Federation
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Review
For citations:
Shilo V.Yu., Denisov A.Yu., Kozlova T.V. Heritable and acquired thrombophilias and the risk for hemodialysis arteriovenous fistula thrombosis. Nephrology and Dialysis. 2005;7(2):161-167. (In Russ.)
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