State-of-the-Art Review : Increased Activated Protein C: Protein C Inhibitor Complex and Decreased Protein C Inhibitor Levels in Patients with Chronic Renal Failure on Maintenance Hemodialysis

Hemostatic abnormalities were examined in 55 pa tients during maintenance hemodialysis (HD). Before HD, plasma protein C and protein S antigens were almost within the normal range, while plasma thrombin-antithrombin III complex (TAT III) and plasmin-plasmin inhibitor complex (PPIC) levels in HD patients were increased slightly, and plasminogen acti vator inhibitor 1 level was significantly increased, compared to that in normal volunteers. Plasma activated protein C (APC) and protein C inhibitor (PCI) complex and APC α1 antitrypsin (α1AT) complex were not detected in normal volunteers; how ever, plasma APC-PCI complex was increased in 36 of the patients and plasma APC-α1AT complex was increased in 25 patients. Plasma PCI levels in these patients before HD were significantly decreased. Plasma TAT, PPIC, and tissue type plasminogen activator levels were significantly higher before HD than after 1 hour HD and at the end of HD, while the changes in plasma protein C antigen, protein S antigen, PCI antigen, APC-PCI complex, and APC-α1AT complex were not significant after 1 hour of HD or at the end of HD compared to levels before HD. Plasma PCI levels were correlated with APC- PCI complex, suggesting that decreased PCI levels might be caused by the activation of protein C.