PMID- 11007833
OWN - NLM
STAT- MEDLINE
DCOM- 20001207
LR  - 20220410
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 15
IP  - 10
DP  - 2000 Oct
TI  - Heparins and blood polymorphonuclear stimulation in haemodialysis: an expansion 
      of the biocompatibility concept.
PG  - 1631-7
AB  - BACKGROUND: At the concentrations used in haemodialysis and in a dose-dependent 
      way, unfractionated heparin (UFH) and, to a lesser degree, a low-molecular-weight 
      heparin (LMWH) stimulate polymorphonuclear cells (PMN) in vitro, and could act in 
      synergy with the stimulatory effect of dialysis membranes in vivo. To examine 
      this hypothesis, we studied the effects of different heparin types and regimens 
      on blood PMNs during haemodialysis sessions. METHODS: Ten haemodialysed patients 
      were studied during regular dialysis sessions on a cellulose triacetate membrane 
      (CT 110 G; 1.10 m(2); Baxter), with four different random heparin protocols: one 
      high-UFH regimen (HHR) at 90 IU/kg body-weight (b.w.) and one low-UFH regimen 
      (LHR) at 50 IU/kg b.w., and with a LMWH (nadroparin calcium) at 85 (HHR) or 45 
      (LHR) IU/kg b.w. Blood granulocytes, platelet counts, and plasma granulocyte 
      degranulation products (elastase, lactoferrin) were measured serially during 4 h 
      dialysis sessions. RESULTS: After 10 min, the reduction in PMNs with UFH was 
      29.5% for HHR (P<0.01) and 28.5% for LHR (P<0.01), and only 16.8 and 18.6% with 
      LMWH (NS), significantly higher for HHR with UFH than with LMWH (P<0.01). At 60 
      min, the elastase increase with HHR was greater, 61% with UFH (P<0.01) and 37.8% 
      with LMWH (P<0.01), significantly higher than LHR for UFH (P<0.05) or LMWH 
      (P<0.05). The overall decrease in platelets (with LMWH P<0.01) and the overall 
      increase in lactoferrin (P<0.001) were not different between heparinization 
      procedures. CONCLUSION: Under a conventional heparin regimen, the PMN variation 
      during the course of the dialysis session suggests a more biocompatible effect of 
      LMWH over UFH. In addition, the variation of elastase favours the lower dose, 
      whatever the type of heparin. Heparin type and dose should therefore be 
      considered in studies addressing biocompatibility in haemodialysis: a low dose of 
      LMWH may be viewed as a better biocompatible treatment with regard to leukocyte 
      stimulation.
FAU - Leitienne, P
AU  - Leitienne P
AD  - Centre d'Hemodialyse, Hopital P. Wertheimer, et departement de Nephrologie, 
      Hopital Edouard Herriot, Lyon, France.
FAU - Fouque, D
AU  - Fouque D
FAU - Rigal, D
AU  - Rigal D
FAU - Adeleine, P
AU  - Adeleine P
FAU - Trzeciak, M C
AU  - Trzeciak MC
FAU - Laville, M
AU  - Laville M
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Anticoagulants)
RN  - 0 (Biocompatible Materials)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.- (Lactoferrin)
RN  - EC 3.4.21.36 (Pancreatic Elastase)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Biocompatible Materials/therapeutic use
MH  - Cell Degranulation/physiology
MH  - Chemical Fractionation
MH  - Female
MH  - Heparin/*chemistry/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Kidney Failure, Chronic/blood/*therapy
MH  - Lactoferrin/blood
MH  - Leukocyte Count
MH  - Male
MH  - Middle Aged
MH  - Neutrophils/*drug effects/physiology
MH  - Pancreatic Elastase/blood
MH  - Platelet Count
MH  - *Renal Dialysis
EDAT- 2000/09/29 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/29 11:00
PHST- 2000/09/29 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/29 11:00 [entrez]
AID - 10.1093/ndt/15.10.1631 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2000 Oct;15(10):1631-7. doi: 10.1093/ndt/15.10.1631.