Loss of von Willebrand factor large multimers in patients undergoing hemodialysis: A single-center, retrospective study
Yoshinari Fujii a) b), Satomi Nagaya b), Taro Kanno c), Shinya Yamada d), Misako Suzuki e), Kota Goto e), Hisanori Horiuchi e), Masanori Matsumoto f), Eriko Morishita b), d)
a) Department of Medical Technology and Clinical Engineering, Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Ishikawa, Japan
b) Department of Clinical Laboratory Science, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
c) Kanno Dialysis and Vascular Access Clinic, Matsumoto, Nagano, Japan
d) Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
e) Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
f) Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara, Japan
Abstract
Introduction
Von Willebrand factor (VWF) is produced by vascular endothelial cells as large multimers and is cleaved by ADAMTS13 into an appropriate size in a shear stress-dependent manner. Excessive shear stress enhances VWF cleavage, leading to a hemorrhagic disease known as acquired von Willebrand syndrome. No clear reports on the prevalence of the loss of VWF large multimers in patients receiving hemodialysis are currently available. Therefore, this study investigated the prevalence of the loss of VWF large multimers in patients undergoing hemodialysis.
Methods
This single-center, retrospective study involved 90 patients undergoing hemodialysis and 32 healthy participants as controls. VWF antigen levels (VWF:Ag), VWF activity (VWF:RCo), and ADAMTS13 activity were measured. VWF multimer analysis was performed by modified western blotting with an agarose gel electrophoresis, followed by densitometric evaluation of band intensities to calculate the VWF large multimer index (VWF-LMI). A VWF-LMI <80 % was defined as the loss of VWF large multimers, and the prevalence of the loss of VWF large multimers was calculated.
Results
VWF:Ag and VWF:RCo levels in patients undergoing hemodialysis were significantly higher than those in healthy individuals (p < 0.01 both) and were negatively correlated with ADAMTS13 activity (p < 0.01, R = −0.353 and p < 0.01, R = −0.392, respectively). A VWF-LMI <80 % was present in 24 of 90 patients.
Conclusions
The loss of VWF large multimers was identified in 26.7 % of patients receiving hemodialysis. However, the prevalence of the loss of VWF multimers in these patients may be underestimated, as their relatively high VWF activity makes significant bleeding manifestations less likely.