Scientific publications

Haemostatic changes in systemic inflammatory response syndrome during continuous renal replacement therapy

García-Fernández N, Lavilla FJ, Rocha E, Purroy A.
Dept. of Nephrology. University Clinic of Navarra. School of Medicine. University of Navarra. Pamplona (Spain)

Magazine: Journal of Nephrology

Date: Jul 1, 2000

Nephrology [SP]

Endothelial damage and hemostatic imbalance play an important role in the evolution of the Systemic Inflammatory Response Syndrome (SIRS) into the Multiple Organ Dysfunction Syndrome (MODS). In Acute Renal Failure associated with SIRS, different types of Continuous Renal Replacement Therapies (CRRT) may give non-renal benefits by modifying the levels of some factors related to those disturbances.

Forty patients with SIRS-associated ARF were randomised to receive either continuous venovenous hemofiltration (CVVH) or continuous venovenous hemodiafiltration (CVVHDF) for the first 24 h. Afterwards the CRRT method was reversed. The group treated with CVVH moved to CVVHDF and that treated with CVVHDF to CVVH for the next 24 h. Plasma levels of: von Willebrand Factor (vWF), thrombomodulin, plasminogen activity inhibitor type 1 (PAI-1: antigen and activity), tissue type plasminogen activator (t-PA: antigen), prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complexes (TAT) were measured previously to CRRT (base-line), and after 24 and 48 hours of therapy. Multivariate ANOVA was the statistical method used.

In the MANOVA study a significant decrease in PAI-1 activity during the treatment procedure was observed (horizontality p <0.05). PAI-1 antigen showed a tendency to decrease although without statististical significance. There were no significantly different changes in the other factors analysed during either CRRT (parallelism p >0.05). At the base-line point, all the factors were higher than normal values in healthy adults.

The present study suggests that CRRT, in patients with SIRS, may promote a decrease in PAI-1 and consequently, a better outcome. There were no differences between the CVVH and the CVVHDF methods regarding the factors analysed. The present data confirms that there is an important endothelial and hemostatic dysfunction in SIRS from the early phases.

CITATION   J Nephrol. 2000 Jul-Aug;13(4):282-9

you maybe interested


The Clínica is the greater private hospital with technological equipment of Spain, all in a single center.

Imagen de un PET, tecnología de vanguardia en la Clínica Universidad de Navarra


The professionals of the Clínica perform continuous research and training, always to the benefit of the patient.

Imagen profesionales de la Clínica Universidad de Navarra


Learn why we are different from other healthcare centers. Quality, speed, comfort and results.

Imagen del edificio de la Clínica Universidad de Navarra