Semin Thromb Hemost 2011; 37(8): 946-954
DOI: 10.1055/s-0031-1297373
© Thieme Medical Publishers

Thrombosis and Occlusion of Vascular Access in Hemodialyzed Patients

Martina Montagnana1 , Tiziana Meschi2 , Loris Borghi2 , Giuseppe Lippi3
  • 1Sezione di Biochimica Clinica, Dipartimento di Scienze della Vita e della Riproduzione, Università degli Studi di Verona
  • 2Sezione di Medicina Interna e Lungodegenza Critica, Dipartimento di Scienze Cliniche, Azienda Ospedaliero-Universitaria di Parma, Parma
  • 3U.O. Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Italy
Further Information

Publication History

Publication Date:
23 December 2011 (online)

ABSTRACT

Patients undergoing chronic hemodialysis have a high risk of arterial thrombotic events as well as vascular access thrombosis (VAT). The latter complication has been consistently associated with inherited (i.e., the prothrombin 20210 polymorphism, and polymorphisms in the genes encoding for transforming growth factor-β1, nitric oxide synthase, plasminogen activator inhibitor-1, angiotensin converting enzyme, and methylene tetrahydrofolate reductase), and acquired thrombotic risk factors (i.e., diabetes, obesity, atrial fibrillation, hypertension, hyperhomocysteinemia, hyperlipoproteinemia(a), low serum albumin, antiphospholipid antibodies, autoantibodies against protein C and S, erythropoietin administration, malnutrition, and cytomegalovirus infection). The three main factors involved in the pathogenesis of VAT overlap those of venous thrombosis and therefore include endothelial cell injury, blood stasis, and hypercoagulability. These changes are characteristic of patients affected by end-stage renal disease and might be further aggravated during and after hemodialysis. The aim of this review is to describe the epidemiology and pathogenesis of thrombosis of dialysis vascular access and to discuss the application of therapeutic interventions in prevention and treatment of this clinical problem.

REFERENCES

  • 1 Lindner A, Charra B, Sherrard D J, Scribner B H. Accelerated atherosclerosis in prolonged maintenance hemodialysis.  N Engl J Med. 1974;  290 (13) 697-701
  • 2 Winkelmayer W C. Tackling the Achilles' heel of hemodialysis.  N Engl J Med. 2011;  364 (4) 372-374
  • 3 Swartz R D, Messana J M, Boyer C J, Lunde N M, Weitzel W F, Hartman T L. Successful use of cuffed central venous hemodialysis catheters inserted percutaneously.  J Am Soc Nephrol. 1994;  4 (9) 1719-1725
  • 4 Trerotola S O, Johnson M S, Harris V J et al.. Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologists.  Radiology. 1997;  203 (2) 489-495
  • 5 Li L, Terry C M, Shiu Y T, Cheung A K. Neointimal hyperplasia associated with synthetic hemodialysis grafts.  Kidney Int. 2008;  74 (10) 1247-1261
  • 6 Akoh J A. Prosthetic arteriovenous grafts for hemodialysis.  J Vasc Access. 2009;  10 (3) 137-147
  • 7 Murad M H, Elamin M B, Sidawy A N et al.. Autogenous versus prosthetic vascular access for hemodialysis: a systematic review and meta-analysis.  J Vasc Surg. 2008;  48 (5, Suppl) 34S-47S
  • 8 National Kidney Foundation-Dialysis Outcomes Quality Initiative . NKF-DOQI clinical practice guidelines for vascular access.  Am J Kidney Dis. 1997;  30 (4, Suppl 3) S150-S191
  • 9 Papanikolaou V, Papagiannis A, Vrochides D et al.. The natural history of vascular access for hemodialysis: a single center study of 2,422 patients.  Surgery. 2009;  145 (3) 272-279
  • 10 Huber T S, Carter J W, Carter R L, Seeger J M. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review.  J Vasc Surg. 2003;  38 (5) 1005-1011
  • 11 Gibson K D, Gillen D L, Caps M T, Kohler T R, Sherrard D J, Stehman-Breen C O. Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study.  J Vasc Surg. 2001;  34 (4) 694-700
  • 12 Gilpin V, Nichols W K. Vascular access for hemodialysis: thrills and thrombosis.  J Vasc Nurs. 2010;  28 (2) 78-83
  • 13 Kherlakian G M, Roedersheimer L R, Arbaugh J J, Newmark K J, King L R. Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis.  Am J Surg. 1986;  152 (2) 238-243
  • 14 Tordoir J H, Herman J M, Kwan T S, Diderich P M. Long-term follow-up of the polytetrafluoroethylene (PTFE) prosthesis as an arteriovenous fistula for haemodialysis.  Eur J Vasc Surg. 1988;  2 (1) 3-7
  • 15 Ascher E, Gade P, Hingorani A et al.. Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations.  J Vasc Surg. 2000;  31 (1 Pt 1) 84-92
  • 16 Ponikvar R, Buturović-Ponikvar J. Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients.  Ther Apher Dial. 2005;  9 (3) 250-253
  • 17 Blankestijn P. Cuffed tunneled catheters for long-term vascular access. In: Conlon P J, Nicholson M, Schwab S, eds. Hemodialysis Vascular Access: Practice and Problems. New York: Oxford University; 2004: 67-84
  • 18 Moureau N, Poole S, Murdock M A, Gray S M, Semba C P. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients.  J Vasc Interv Radiol. 2002;  13 (10) 1009-1016
  • 19 Agarwal A K. Central vein stenosis: current concepts.  Adv Chronic Kidney Dis. 2009;  16 (5) 360-370
  • 20 Agarwal A K, Patel B M, Haddad N J. Central vein stenosis: a nephrologist's perspective.  Semin Dial. 2007;  20 (1) 53-62
  • 21 Lippi G, Franchini M. Pathogenesis of venous thromboembolism: when the cup runneth over.  Semin Thromb Hemost. 2008;  34 (8) 747-761
  • 22 Lippi G, Franchini M, Favaloro E J. Unsuspected triggers of venous thromboembolism—trivial or not so trivial?.  Semin Thromb Hemost. 2009;  35 (7) 597-604
  • 23 Montagnana M, Favaloro E J, Franchini M, Guidi G C, Lippi G. The role of ethnicity, age and gender in venous thromboembolism.  J Thromb Thrombolysis. 2010;  29 (4) 489-496
  • 24 Casserly L F, Dember L M. Thrombosis in end-stage renal disease.  Semin Dial. 2003;  16 (3) 245-256
  • 25 Paulson W D. Prediction of hemodialysis synthetic graft thrombosis: can we identify factors that impair validity of the dysfunction hypothesis?.  Am J Kidney Dis. 2000;  35 (5) 973-975
  • 26 Brophy D F, Bukaveckas B L, Ferreira-Gonzalez A, Archer K J, Martin E J, Gehr T W. A pilot study of genetic polymorphisms and hemodialysis vascular access thrombosis.  Hemodial Int. 2009;  13 (1) 19-26
  • 27 Knoll G A, Wells P S, Young D et al.. Thrombophilia and the risk for hemodialysis vascular access thrombosis.  J Am Soc Nephrol. 2005;  16 (4) 1108-1114
  • 28 Ataç B, Yakupoğlu U, Ozbek N, Ozdemir F N, Bilgin N. Role of genetic mutations in vascular access thrombosis among hemodialysis patients waiting for renal transplantation.  Transplant Proc. 2002;  34 (6) 2030-2032
  • 29 Bremer C, Schaefer R M. Heterozygosity for factor V Leiden in a haemodialysis patient with recurrent shunt thrombosis.  Nephrol Dial Transplant. 1997;  12 (8) 1775-1776
  • 30 Rios D R, Fernandes A P, Carvalho M G et al.. Hemodialysis vascular access thrombosis: The role of factor V Leiden, prothrombin gene mutation and ABO blood groups.  Clin Chim Acta. 2011;  412 (5-6) 425-429
  • 31 Födinger M, Mannhalter C, Pabinger I et al.. Resistance to activated protein C (APC): mutation at Arg506 of coagulation factor V and vascular access thrombosis in haemodialysis patients.  Nephrol Dial Transplant. 1996;  11 (4) 668-672
  • 32 Fekih-Mrissa N, Klai S, Bafoun A, Nciri B, Hmida J, Gritli N. Role of thrombophilia in vascular access thrombosis among chronic hemodialysis patients in Tunisia.  Ther Apher Dial. 2011;  15 (1) 40-43
  • 33 Heine G H, Ulrich C, Sester U, Sester M, Köhler H, Girndt M. Transforming growth factor beta1 genotype polymorphisms determine AV fistula patency in hemodialysis patients.  Kidney Int. 2003;  64 (3) 1101-1107
  • 34 Girndt M, Heine G H, Ulrich C, Köhler H. DialGene Consortium . Gene polymorphism association studies in dialysis: vascular access.  Semin Dial. 2007;  20 (1) 63-67
  • 35 Stracke S, Konner K, Köstlin I et al.. Increased expression of TGF-beta1 and IGF-I in inflammatory stenotic lesions of hemodialysis fistulas.  Kidney Int. 2002;  61 (3) 1011-1019
  • 36 Lazo-Langner A, Knoll G A, Wells P S, Carson N, Rodger M A. The risk of dialysis access thrombosis is related to the transforming growth factor-beta1 production haplotype and is modified by polymorphisms in the plasminogen activator inhibitor-type 1 gene.  Blood. 2006;  108 (13) 4052-4058
  • 37 Sung S A, Ko G J, Jo S K, Cho W Y, Kim H K, Lee S Y. Interleukin-10 and tumor necrosis factor-alpha polymorphisms in vascular access failure in patients on hemodialysis: preliminary data in Korea.  J Korean Med Sci. 2008;  23 (1) 89-93
  • 38 Basaran O, Atac F B, Karakayali F et al.. Endothelial nitric oxide synthase gene intron 4 (VNTR) polymorphism and vascular access graft thrombosis.  J Invest Surg. 2007;  20 (1) 49-53
  • 39 Trimarchi H, Duboscq C, Genoud V et al.. Plasminogen activator inhibitor-1 activity and 4G/5G polymorphism in hemodialysis.  J Vasc Access. 2008;  9 (2) 142-147
  • 40 Güngör Y, Kayataş M, Yıldız G, Özdemir Ö, Candan F. The presence of PAI-1 4G/5G and ACE DD genotypes increases the risk of early-stage AVF thrombosis in hemodialysis patients.  Ren Fail. 2011;  33 (2) 169-175
  • 41 Rigat B, Hubert C, Alhenc-Gelas F, Cambien F, Corvol P, Soubrier F. An insertion/deletion polymorphism in the angiotensin I-converting enzyme gene accounting for half the variance of serum enzyme levels.  J Clin Invest. 1990;  86 (4) 1343-1346
  • 42 Sajgure A, Choudhury A, Ahmed Z, Choudhury D. Angiotensin converting enzyme inhibitors maintain polytetrafluroethylene graft patency.  Nephrol Dial Transplant. 2007;  22 (5) 1390-1398
  • 43 Heine G H, Ulrich C, Köhler H, Girndt M. Is AV fistula patency associated with angiotensin-converting enzyme (ACE) polymorphism and ACE inhibitor intake?.  Am J Nephrol. 2004;  24 (4) 461-468
  • 44 Molino D, De Lucia D, Marotta R et al.. In uremia, plasma levels of anti-protein C and anti-protein S antibodies are associated with thrombosis.  Kidney Int. 2005;  68 (3) 1223-1229
  • 45 Windus D W, Jendrisak M D, Delmez J A. Prosthetic fistula survival and complications in hemodialysis patients: effects of diabetes and age.  Am J Kidney Dis. 1992;  19 (5) 448-452
  • 46 Chou C Y, Chen J Y, Liu J H et al.. Atrial fibrillation linked to vascular access thrombosis in chronic hemodialysis patients.  J Atheroscler Thromb. 2011;  18 (6) 448-453
  • 47 Erkut B, Unlü Y, Ceviz M et al.. Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency.  Ren Fail. 2006;  28 (4) 275-281
  • 48 Obialo C I, Robinson T, Brathwaite M. Hemodialysis vascular access: variable thrombus-free survival in three subpopulations of black patients.  Am J Kidney Dis. 1998;  31 (2) 250-256
  • 49 Moustapha A, Naso A, Nahlawi M et al.. Prospective study of hyperhomocysteinemia as an adverse cardiovascular risk factor in end-stage renal disease.  Circulation. 1998;  97 (2) 138-141
  • 50 Fermo I, Vigano' D'Angelo S, Paroni R, Mazzola G, Calori G, D'Angelo A. Prevalence of moderate hyperhomocysteinemia in patients with early-onset venous and arterial occlusive disease.  Ann Intern Med. 1995;  123 (10) 747-753
  • 51 Zoccali C, Mallamaci F, Tripepi G. It is important to lower homocysteine in dialysis patients.  Semin Dial. 2007;  20 (6) 530-533
  • 52 Mallamaci F, Bonanno G, Seminara G et al.. Hyperhomocysteinemia and arteriovenous fistula thrombosis in hemodialysis patients.  Am J Kidney Dis. 2005;  45 (4) 702-707
  • 53 Churchill D N, Taylor D W, Cook R J et al.. Canadian hemodialysis morbidity study.  Am J Kidney Dis. 1992;  19 (3) 214-234
  • 54 Molino D, De Santo N G, Marotta R, Anastasio P, Mosavat M, De Lucia D. Plasma levels of plasminogen activator inhibitor type 1, factor VIII, prothrombin activation fragment 1 + 2, anticardiolipin, and antiprothrombin antibodies are risk factors for thrombosis in hemodialysis patients.  Semin Nephrol. 2004;  24 (5) 495-501
  • 55 Goldwasser P, Michel M A, Collier J et al.. Prealbumin and lipoprotein(a) in hemodialysis: relationships with patient and vascular access survival.  Am J Kidney Dis. 1993;  22 (1) 215-225
  • 56 Chou C Y, Kuo H L, Yung Y F, Liu Y L, Huang C C. C-reactive protein predicts vascular access thrombosis in hemodialysis patients.  Blood Purif. 2006;  24 (4) 342-346
  • 57 Muirhead N, Laupacis A, Wong C. Erythropoietin for anemia in hemodialysis patients: Results of a maintenance study.  Nephrol Dial Transplant. 1992;  7 811-816
  • 58 al-Momen A K, Huraib S O, Gader A M, Sulaimani F. Low dose danazol is effective in management of erythropoietin induced thrombosis.  Thromb Res. 1991;  64 (5) 527-532
  • 59 Lee Y K, Koo J R, Kim J K et al.. Effect of route of EPO administration on hemodialysis arteriovenous vascular access failure: a randomized controlled trial.  Am J Kidney Dis. 2009;  53 (5) 815-822
  • 60 Canadian Erythropoietin Study Group . Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis.  BMJ. 1990;  300 (6724) 573-578
  • 61 Palmer S C, Navaneethan S D, Craig J C et al.. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease.  Ann Intern Med. 2010;  153 (1) 23-33
  • 62 Tang I Y, Vrahnos D, Valaitis D, Lau A H. Vascular access thrombosis during recombinant human erythropoietin therapy.  ASAIO J. 1992;  38 (3) M528-M531
  • 63 Standage B A, Schuman E S, Ackerman D, Gross G F, Ragsdale J W. Does the use of erythropoietin in hemodialysis patients increase dialysis graft thrombosis rates?.  Am J Surg. 1993;  165 (5) 650-654
  • 64 Brunet P, Aillaud M F, San Marco M et al.. Antiphospholipids in hemodialysis patients: relationship between lupus anticoagulant and thrombosis.  Kidney Int. 1995;  48 (3) 794-800
  • 65 Prakash R, Miller III C C, Suki W N. Anticardiolipin antibody in patients on maintenance hemodialysis and its association with recurrent arteriovenous graft thrombosis.  Am J Kidney Dis. 1995;  26 (2) 347-352
  • 66 Prieto L N, Suki W N. Frequent hemodialysis graft thrombosis: association with antiphospholipid antibodies.  Am J Kidney Dis. 1994;  23 (4) 587-590
  • 67 Shalhoub R J. Pathogenesis of lipoid nephrosis: a disorder of T-cell function.  Lancet. 1974;  2 (7880) 556-560
  • 68 Gültekin F, Alagözlü H, Candan F, Nadir I, Bakici M Z, Sezer H. The relationship between anticardiolipin antibodies and vascular access occlusion in patients on hemodialysis.  ASAIO J. 2005;  51 (2) 162-164
  • 69 Chuang F R, Chen T C, Yang C C et al.. IgM-anticardiolipin antibody and vascular access thrombosis in chronic hemodialysis patients.  Ren Fail. 2005;  27 (1) 25-30
  • 70 Weisinger J R, Kempson R L, Eldridge F L, Swenson R S. The nephrotic syndrome: a complication of massive obesity.  Ann Intern Med. 1974;  81 (4) 440-447
  • 71 Cull J D, Cull D L, Taylor S M et al.. Prosthetic thigh arteriovenous access: outcome with SVS/AAVS reporting standards.  J Vasc Surg. 2004;  39 (2) 381-386
  • 72 Gagliardi G M, Rossi S, Condino F et al.. Malnutrition, infection and arteriovenous fistula failure: is there a link?.  J Vasc Access. 2011;  12 (1) 57-62
  • 73 Lin C C, Yang W C. Prognostic factors influencing the patency of hemodialysis vascular access: literature review and novel therapeutic modality by far infrared therapy.  J Chin Med Assoc. 2009;  72 (3) 109-116
  • 74 Himmelfarb J, Stenvinkel P, Ikizler T A, Hakim R M. The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia.  Kidney Int. 2002;  62 (5) 1524-1538
  • 75 Malyszko J. Mechanism of endothelial dysfunction in chronic kidney disease.  Clin Chim Acta. 2010;  411 (19-20) 1412-1420
  • 76 Roy-Chaudhury P, Kelly B S, Miller M A et al.. Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts.  Kidney Int. 2001;  59 (6) 2325-2334
  • 77 Weiss M F, Scivittaro V, Anderson J M. Oxidative stress and increased expression of growth factors in lesions of failed hemodialysis access.  Am J Kidney Dis. 2001;  37 (5) 970-980
  • 78 Swedberg S H, Brown B G, Sigley R, Wight T N, Gordon D, Nicholls S C. Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment.  Circulation. 1989;  80 (6) 1726-1736
  • 79 Reddy M K, Vasir J K, Hegde G V, Joshi S S, Labhasetwar V. Erythropoietin induces excessive neointima formation: a study in a rat carotid artery model of vascular injury.  J Cardiovasc Pharmacol Ther. 2007;  12 (3) 237-247
  • 80 Douzdjian V, Abecassis M M. A new technique of prosthetic arteriovenous fistula construction that eliminates the need for temporary access.  Am J Surg. 1993;  166 (3) 304-305
  • 81 Barth C, Boer W, Garzoni D et al.. Characteristics of hypotension-prone haemodialysis patients: is there a critical relative blood volume?.  Nephrol Dial Transplant. 2003;  18 (7) 1353-1360
  • 82 Kao C L, Chang J P. Fully ringed polytetrafluoroethylene graft for vascular access in hemodialysis.  Asian Cardiovasc Thorac Ann. 2003;  11 (2) 171-173
  • 83 Miller P E, Carlton D, Deierhoi M H, Redden D T, Allon M. Natural history of arteriovenous grafts in hemodialysis patients.  Am J Kidney Dis. 2000;  36 (1) 68-74
  • 84 Nampoory M R, Das K C, Johny K V et al.. Hypercoagulability, a serious problem in patients with ESRD on maintenance hemodialysis, and its correction after kidney transplantation.  Am J Kidney Dis. 2003;  42 (4) 797-805
  • 85 Ambühl P M, Wüthrich R P, Korte W, Schmid L, Krapf R. Plasma hypercoagulability in haemodialysis patients: impact of dialysis and anticoagulation.  Nephrol Dial Transplant. 1997;  12 (11) 2355-2364
  • 86 Milburn J A, Cassar K, Ford I, Fluck N, Brittenden J. Prothrombotic changes in platelet, endothelial and coagulation function following hemodialysis.  Int J Artif Organs. 2011;  34 (3) 280-287
  • 87 Schoorl M, Schoorl M, Nubé M J, Bartels P C. Platelet depletion, platelet activation and coagulation during treatment with hemodialysis.  Scand J Clin Lab Invest. 2011;  71 (3) 240-247
  • 88 Mercier E, Branger B, Vecina F et al.. Tissue factor coagulation pathway and blood cells activation state in renal insufficiency.  Hematol J. 2001;  2 (1) 18-25
  • 89 Spijker H T, Graaff R, Boonstra P W, Busscher H J, van Oeveren W. On the influence of flow conditions and wettability on blood material interactions.  Biomaterials. 2003;  24 (26) 4717-4727
  • 90 Jurk K, Kehrel B E. Platelets: physiology and biochemistry.  Semin Thromb Hemost. 2005;  31 (4) 381-392
  • 91 Flaumenhaft R, Mairuhu A T, Italiano J E. Platelet- and megakaryocyte-derived microparticles.  Semin Thromb Hemost. 2010;  36 (8) 881-887
  • 92 Ando M, Iwata A, Ozeki Y, Tsuchiya K, Akiba T, Nihei H. Circulating platelet-derived microparticles with procoagulant activity may be a potential cause of thrombosis in uremic patients.  Kidney Int. 2002;  62 (5) 1757-1763
  • 93 Cianciolo G, Stefoni S, Donati G et al.. Intra- and post-dialytic platelet activation and PDGF-AB release: cellulose diacetate vs polysulfone membranes.  Nephrol Dial Transplant. 2001;  16 (6) 1222-1229
  • 94 Gritters-van den Oever M, Schoorl M, Schoorl M, Bartels P C, Grooteman M P, Nubé M J. The role of the extracorporeal circuit in the trapping and degranulation of platelets.  Blood Purif. 2009;  28 (3) 253-259
  • 95 Schoorl M, Schoorl M, Bartels P C. Changes in platelet volume, morphology and RNA content in subjects treated with haemodialysis.  Scand J Clin Lab Invest. 2008;  68 (4) 335-342
  • 96 Itoh S, Takeshita K, Susuki C, Shige-Eda K, Tsuji T. Redistribution of P-selectin ligands on neutrophil cell membranes and the formation of platelet-neutrophil complex induced by hemodialysis membranes.  Biomaterials. 2008;  29 (21) 3084-3090
  • 97 Sirolli V, Ballone E, Di Stante S, Amoroso L, Bonomini M. Cell activation and cellular-cellular interactions during hemodialysis: effect of dialyzer membrane.  Int J Artif Organs. 2002;  25 (6) 529-537
  • 98 Frank R D, Weber J, Dresbach H, Thelen H, Weiss C, Floege J. Role of contact system activation in hemodialyzer-induced thrombogenicity.  Kidney Int. 2001;  60 (5) 1972-1981
  • 99 Basmadjian D, Sefton M V, Baldwin S A. Coagulation on biomaterials in flowing blood: some theoretical considerations.  Biomaterials. 1997;  18 (23) 1511-1522
  • 100 Lucchi L, Ligabue G, Marietta M et al.. Activation of coagulation during hemodialysis: effect of blood lines alone and whole extracorporeal circuit.  Artif Organs. 2006;  30 (2) 106-110
  • 101 Kushiya F, Wada H, Sakakura M et al.. Atherosclerotic and hemostatic abnormalities in patients undergoing hemodialysis.  Clin Appl Thromb Hemost. 2003;  9 (1) 53-60
  • 102 Vaziri N D, Gonzales E C, Wang J, Said S. Blood coagulation, fibrinolytic, and inhibitory proteins in end-stage renal disease: effect of hemodialysis.  Am J Kidney Dis. 1994;  23 (6) 828-835
  • 103 Opatrný Jr K, Vít L, Opatrná S, Sulková S, Bodláková B. [Hypofibrinolysis after venous occlusion in patients treated with long-term hemodialysis].  Cas Lek Cesk. 1994;  133 (11) 346-349
  • 104 Lottermoser K, Petras S, Pöge U et al.. The fibrinolytic system in chronic renal failure.  Eur J Med Res. 2001;  6 (9) 372-376
  • 105 De Marchi S, Falleti E, Giacomello R et al.. Risk factors for vascular disease and arteriovenous fistula dysfunction in hemodialysis patients.  J Am Soc Nephrol. 1996;  7 (8) 1169-1177
  • 106 Inoue A, Wada H, Takagi M et al.. Hemostatic abnormalities in patients with thrombotic complications on maintenance hemodialysis.  Clin Appl Thromb Hemost. 2000;  6 (2) 100-103
  • 107 Fan P Y, Schwab S J. Vascular access: concepts for the 1990s.  J Am Soc Nephrol. 1992;  3 (1) 1-11
  • 108 Young E W, Dykstra D M, Goodkin D A, Mapes D L, Wolfe R A, Held P J. Hemodialysis vascular access preferences and outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS).  Kidney Int. 2002;  61 (6) 2266-2271
  • 109 Eleftheriadis T, Antoniadi G, Akritidou A et al.. A case report of recurrent vascular access thrombosis in a hemodialysis patient reveals combined acquired and inherited thrombophilia.  Ther Apher Dial. 2008;  12 (2) 190-192
  • 110 Sands J J. Vascular access 2007.  Minerva Urol Nefrol. 2007;  59 (3) 237-249
  • 111 Sands J J. Vascular access: the past, present and future.  Blood Purif. 2009;  27 (1) 22-27

Martina MontagnanaM.D. 

Sezione di Biochimica Clinica, Università degli Studi di Verona

Ospedale Policlinico G.B. Rossi, P.le Scuro 10, 37134 Verona, Italy

Email: martina.montagnana@med.lu.se

    >