Background: Fibronectin (FN) is a glycoprotein present in body fluids and tissues and is known to have a binding property involved in the hemostatic mechanism, among other functions. FN is known to be low in chronic renal failure (CRF) patients undergoing regular hemodialysis treatment (RDT).
Objectives: To assess the role of FN in the hypercoagulability of some children with CRF on RDT, particularly clotting in the hollow fiber or occlusion of their arterio-venous fistula (AVF).
Methods: FN was studied in 12 CRF children on RDT having hypercoagulability and requiring higher heparin doses on dialysis, 12 similar children with no coagulation problems and receiving usual heparin doses, and in 10 normal controls.
Results: In all the patients the examined coagulation tests were within the normal ranges and showed no significant differences among the patient groups. Anti-thrombin III was significantly higher in the hypercoagulability group than the healthy controls and insignificantly higher than the normal RDT group. Plasma FN in the normal heparin group (233.75 ± 84.5 mg/L) was significantly lower than in the control cases (328.5 ± 36.5 mg/L) (P ˂ 0.005). The level in the hypercoagulability group (549.17 ± 220.68 mg/L) was significantly higher than the level in the healthy controls (p ˂ 0.005), and consequently more significantly higher than the level in the normal heparin group (p ˂ 0.001). FN was above the normal range in 7/12 cases with hypercoagulability suggesting an important role in inducing coagulation and/or antagonizing the anticoagulant.
Conclusions: The coagulation profile study for RDT patients should include plasma FN as one of its parameters, which could predict higher heparin requirements on dialysis.