PMID- 28418614
OWN - NLM
STAT- MEDLINE
DCOM- 20190130
LR  - 20220331
IS  - 1542-4758 (Electronic)
IS  - 1492-7535 (Linking)
VI  - 22
IP  - 1
DP  - 2018 Jan
TI  - Efficacy and safety of low-dose heparin in hemodialysis.
PG  - 74-81
LID - 10.1111/hdi.12563 [doi]
AB  - INTRODUCTION: The dose of unfractionated heparin (UFH) administered during 
      hemodialysis (HD) varies widely. This prospective study evaluated the safety and 
      efficacy of UFH dose de-escalation. METHODS: Sixty-six prevalent patients on HD 
      receiving UFH per standard-dose protocol (load dose [LD] 50-75 units/kg, 
      maintenance dose [MD] 500-1000 units/hour) had heparin prescription converted to 
      low-dose protocol (start LD 15 units/kg and MD 500 units/hour; dose adjusted in 
      small increments based on assessments of extracorporeal blood circuit). 
      Coagulation parameters, dialysis adequacy, dialyzer clotting, anemia management, 
      and dialyzer reuse rates were compared based on the heparin protocol. FINDINGS: 
      Mean(SD) UFH dose per HD session, before and after protocol conversion, was 
      6178(2644) and 2913(1116) units, respectively (P < 0.0001). This corresponded to 
      LD 52.1(16.6) units/kg and MD 615(207) units/hour with standard-dose protocol, 
      and LD 18.3(6.5) units/kg and MD 505(27) units/hour with low-dose protocol 
      (P < 0.0001). Mid and postdialysis aPTT was 55.3(31.2) and 35.1(7.8) seconds 
      before, and 37.3(12.9) and 31.5(5.3) seconds after conversion (P = 0.007 and 
      0.003, respectively); no significant changes in D-dimer levels occurred. Low-dose 
      UFH was associated with a small increase in URR and spKt/V (73.0 and 1.54) 
      compared with dialysis clearance on standard-dose UFH (71.2 and 1.48, 
      respectively, P = 0.02). Weekly dose of ESA decreased by 2388 units 
      postconversion (P = 0.03), while hemoglobin levels and the weekly dose of 
      intravenous iron did not change (P = 0.16 and 0.78). A small rise in the rate of 
      moderate dialyzer clotting at the end of HD was noted with low-dose UFH (5.7% vs. 
      7.5%, P = 0.002); the rate of severe dialyzer clotting events did not change 
      (P = 0.91). No change in the dialyzer reuse rate was noted (18.5 vs. 17.0 
      treatments, P = 0.26). DISCUSSION: Low-dose heparinization did not compromise 
      dialysis adequacy and permitted ESA dose reduction. Our findings suggest that in 
      prevalent patients on HD, UFH dose of 15-20 units/kg loading and 500 units/hour 
      maintenance was medically safe and effective.
CI  - (c) 2017 International Society for Hemodialysis.
FAU - Murea, Mariana
AU  - Murea M
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Russell, Gregory B
AU  - Russell GB
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Daeihagh, Pirouz
AU  - Daeihagh P
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Saran, Anita M
AU  - Saran AM
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Pandya, Karan
AU  - Pandya K
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Cabrera, Mark
AU  - Cabrera M
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Burkart, John M
AU  - Burkart JM
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
FAU - Freedman, Barry I
AU  - Freedman BI
AD  - Department of Internal Medicine, Section on Nephrology, Wake Forest School of 
      Medicine, Winston-Salem, North Carolina, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170418
PL  - Canada
TA  - Hemodial Int
JT  - Hemodialysis international. International Symposium on Home Hemodialysis
JID - 101093910
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/pharmacology/*therapeutic use
MH  - Female
MH  - Heparin/pharmacology/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Renal Dialysis/*methods
OTO - NOTNLM
OT  - Anemia
OT  - dialyzer
OT  - erythropoietin
OT  - hemodialysis
OT  - heparin
EDAT- 2017/04/19 06:00
MHDA- 2019/01/31 06:00
CRDT- 2017/04/19 06:00
PHST- 2017/04/19 06:00 [pubmed]
PHST- 2019/01/31 06:00 [medline]
PHST- 2017/04/19 06:00 [entrez]
AID - 10.1111/hdi.12563 [doi]
PST - ppublish
SO  - Hemodial Int. 2018 Jan;22(1):74-81. doi: 10.1111/hdi.12563. Epub 2017 Apr 18.