PMID- 22560830
OWN - NLM
STAT- MEDLINE
DCOM- 20121030
LR  - 20240321
IS  - 1523-6838 (Electronic)
IS  - 0272-6386 (Print)
IS  - 0272-6386 (Linking)
VI  - 60
IP  - 3
DP  - 2012 Sep
TI  - Use and safety of unfractionated heparin for anticoagulation during maintenance 
      hemodialysis.
PG  - 473-86
LID - 10.1053/j.ajkd.2012.03.017 [doi]
AB  - Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is 
      the most commonly used anticoagulant in the United States. However, there is no 
      universally accepted standard for its administration in long-term hemodialysis. 
      Dosage schedules vary and include weight-based protocols and low-dose protocols 
      for those at high risk of bleeding, as well as regional anticoagulation with 
      heparin and heparin-coated dialyzers. Adjustments are based largely on clinical 
      signs of under- and overanticoagulation. Risks of UFH use include bleeding, 
      heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly 
      bone mineral disease, hyperkalemia, and catheter-associated sepsis. Alternative 
      anticoagulants include low-molecular-weight heparin, direct thrombin inhibitors, 
      heparinoids, and citrate. Anticoagulant-free hemodialysis and peritoneal dialysis 
      also are potential substitutes. However, some of these alternative treatments are 
      not as available as or are more costly than UFH, are dependent on country and 
      health care system, and present dosing challenges. When properly monitored, UFH 
      is a relatively safe and economical choice for anticoagulation in long-term 
      hemodialysis for most patients.
CI  - Copyright (c) 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All 
      rights reserved.
FAU - Shen, Jenny I
AU  - Shen JI
AD  - Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 
      94305, USA. jishen@stanford.edu
FAU - Winkelmayer, Wolfgang C
AU  - Winkelmayer WC
LA  - eng
GR  - T32 DK007357/DK/NIDDK NIH HHS/United States
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20120505
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
EIN - Am J Kidney Dis. 2012 Dec;60(6):1056
MH  - Anticoagulants/adverse effects/therapeutic use
MH  - Blood Coagulation/drug effects
MH  - Diabetic Nephropathies
MH  - Disease Progression
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Follow-Up Studies
MH  - Hemorrhage/*chemically induced/prevention & control
MH  - Heparin/*adverse effects/therapeutic use
MH  - Humans
MH  - Kidney Failure, Chronic/etiology/*therapy
MH  - Kidney Function Tests
MH  - Long-Term Care
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic/methods
MH  - Patient Safety
MH  - Renal Dialysis/adverse effects/*methods
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Thromboembolism/prevention & control
MH  - Treatment Outcome
PMC - PMC4088960
MID - NIHMS609427
EDAT- 2012/05/09 06:00
MHDA- 2012/10/31 06:00
PMCR- 2014/07/09
CRDT- 2012/05/08 06:00
PHST- 2011/07/18 00:00 [received]
PHST- 2012/03/30 00:00 [accepted]
PHST- 2012/05/08 06:00 [entrez]
PHST- 2012/05/09 06:00 [pubmed]
PHST- 2012/10/31 06:00 [medline]
PHST- 2014/07/09 00:00 [pmc-release]
AID - S0272-6386(12)00660-9 [pii]
AID - 10.1053/j.ajkd.2012.03.017 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 2012 Sep;60(3):473-86. doi: 10.1053/j.ajkd.2012.03.017. Epub 
      2012 May 5.