PMID- 30173320 OWN - NLM STAT- MEDLINE DCOM- 20190927 LR - 20190927 IS - 1432-198X (Electronic) IS - 0931-041X (Linking) VI - 33 IP - 12 DP - 2018 Dec TI - Dalteparin anticoagulation in paediatric home haemodialysis. PG - 2337-2341 LID - 10.1007/s00467-018-4032-1 [doi] AB - BACKGROUND: The aim of this study was to investigate whether dalteparin is a safe and effective anticoagulant for paediatric home haemodialysis (HD) and to assess the determinants of dosing. METHODS: Data were collected for all children (< 18 years) undergoing home HD from 2011 to 2017 at one large paediatric nephrology centre in the UK. All children had anticoagulation with dalteparin sodium according to a standardised protocol. Dalteparin safety was assessed by monitoring for accumulation, adequate clearance of dalteparin and adverse events. Dalteparin efficacy was assessed through monitoring for clot formation in dialysis circuits. Potential determinants of dalteparin dosing were assessed. RESULTS: Eighteen children were included, their median age at start was 12 years, and 50% were male. Eighty-three percent of children had four home HD sessions each week, with a median total dialysis hours of 20 h/week. Thirty-three percent of children had nocturnal home HD. Median dalteparin dose at 12-month follow-up was 40 IU/kg (range 8-142 IU/kg). Factors associated with higher dalteparin dosing requirements included a younger age of the child (p < 0.01), a lower blood flow rate (p < 0.01) and the use of a central venous line for dialysis access (p = 0.038). No children had evidence of bioaccumulation of dalteparin or inadequate clearance. No significant bleeding or adverse events were reported. CONCLUSIONS: Dalteparin is a safe and effective anticoagulant when used for paediatric home HD. In this study, there was no evidence of bioaccumulation or significant adverse events. Further research is required to directly compare dalteparin with unfractionated heparin (UFH) and evaluate anticoagulant choice for paediatric home HD. FAU - Lutkin, Miranda AU - Lutkin M AD - Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. FAU - Stronach, Lynsey AU - Stronach L AD - Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. FAU - Yadav, Pallavi AU - Yadav P AD - Department of Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. FAU - Hothi, Daljit K AU - Hothi DK AD - Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. Daljit.Hothi@gosh.nhs.uk. LA - eng PT - Journal Article PT - Observational Study DEP - 20180901 PL - Germany TA - Pediatr Nephrol JT - Pediatric nephrology (Berlin, Germany) JID - 8708728 RN - 0 (Anticoagulants) RN - S79O08V79F (Dalteparin) SB - IM MH - Adolescent MH - Age Factors MH - Anticoagulants/*administration & dosage MH - Blood Coagulation/drug effects MH - Child MH - Child, Preschool MH - Dalteparin/*administration & dosage/adverse effects MH - Dose-Response Relationship, Drug MH - Female MH - Follow-Up Studies MH - Hemodialysis, Home/*adverse effects MH - Hemorrhage/chemically induced/epidemiology MH - Humans MH - Kidney Failure, Chronic/*therapy MH - Male MH - Retrospective Studies MH - Thrombosis/*prevention & control MH - United Kingdom OTO - NOTNLM OT - Anticoagulation OT - Dosing OT - Haemodialysis OT - Low molecular OT - Safety OT - Weight heparin EDAT- 2018/09/03 06:00 MHDA- 2019/09/29 06:00 CRDT- 2018/09/03 06:00 PHST- 2017/11/15 00:00 [received] PHST- 2018/07/20 00:00 [accepted] PHST- 2018/07/04 00:00 [revised] PHST- 2018/09/03 06:00 [pubmed] PHST- 2019/09/29 06:00 [medline] PHST- 2018/09/03 06:00 [entrez] AID - 10.1007/s00467-018-4032-1 [pii] AID - 10.1007/s00467-018-4032-1 [doi] PST - ppublish SO - Pediatr Nephrol. 2018 Dec;33(12):2337-2341. doi: 10.1007/s00467-018-4032-1. Epub 2018 Sep 1.