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Hemodialysis heparin

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https://www.readbyqxmd.com/read/28425077/unexpected-and-striking-effect-of-heparin-free-dialysis-on-cytokine-release
#1
Alicja Rydzewska-Rosolowska, Joanna Gozdzikiewicz-Lapinska, Jacek Borawski, Ewa Koc-Zorawska, Michal Mysliwiec, Beata Naumnik
Heparin (both unfractionated and low molecular weight) is not only a potent anticoagulant but also has many pleiotropic effects, some of which are mediated by cytokine release. We compared the effect of hemodialysis (HD) with enoxaparin as an anticoagulant and without systemic anticoagulation (heparin-grafted membrane-Evodial) on the release of monocyte chemoattractant protein 1 (MCP-1), endostatin (ES) and activin A (Act-A). Nineteen stable HD patients were dialyzed with or without heparin, and plasma levels of MCP-1, ES and Act-A were measured after such a dialysis...
April 19, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28420841/tranexamic-acid-controlled-chronic-disseminated-intravascular-coagulation-associated-with-aortic-dissection-and-patent-false-lumen-for-three-years
#2
Yodo Gatate, Nobuyuki Masaki, Atsushi Sato, Risako Yasuda, Takayuki Namba, Hirotaka Yada, Akio Kawamura, Takeshi Adachi
The management of chronic disseminated intravascular coagulation (DIC) caused by aortic dissection has not yet been established. Even in cases where surgical correction is performed, therapeutic control of systemic hemorrhaging is still required. We herein report the successful treatment of a case of aortic dissection with a patent false lumen using tranexamic acid for acute exacerbation of chronic DIC. Oral administration of 1,500 mg tranexamic acid per day stabilized the coagulative and fibrinolytic parameters and relieved bleeding tendencies with no side effects...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28418614/efficacy-and-safety-of-low-dose-heparin-in-hemodialysis
#3
Mariana Murea, Gregory B Russell, Pirouz Daeihagh, Anita M Saran, Karan Pandya, Mark Cabrera, John M Burkart, Barry I Freedman
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)...
April 18, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28381917/dosing-of-enoxaparin-in-renal-impairment
#4
Suhail A Shaikh, Randolph E Regal
OBJECTIVE: To review enoxaparin treatment dosing, pharmacokinetics, and clinical outcomes data in patients with renal impairment and to examine the current two-tiered dosing regimen approved by the Food and Drug Administration (FDA). DATA SOURCES: A literature search of PubMed (1990-2016) was performed using the search terms low-molecular-weight heparin, unfractionated heparin, bleeding, enoxaparin, renal impairment, pharmacokinetics, and hemodialysis. STUDY SELECTION AND DATA EXTRACTION: All studies assessing the pharmacokinetic properties of enoxaparin in patients with renal impairment were evaluated...
April 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28375903/bleeding-risk-of-antithrombotic-treatment-in-patients-on-hemodialysis
#5
Eduardo Vázquez, Carmen Sánchez-Perales, Sonia Ortega, Teresa Vázquez-Sánchez, Enrique Quesada, Daniel Salas, Juan Carlos Fernández-Guerrero
BACKGROUND: The risk-benefit of antithrombotic treatment (ATT) has not been established in patients on dialysis. Our objective was to determine the influence of ATT on the risk of hemorrhage in patients on hemodialysis. METHODS: We included patients who began dialysis between 2003 and 2007. We determined the rates of fatal bleeding or bleeding leading to hospitalization or transfusion. RESULTS: Two hundred twenty-one patients were included...
April 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28344423/anti-platelet-factor-4-heparin-antibody-plays-a-significant-role-in-progression-of-arterial-stiffness-among-hemodialysis-patients
#6
Chieh Kuo, Chiang-Chin Tsai, Chien-An Chen, Yueh-Feng Tsai, Yen-Hsun Chen
BACKGROUND: Arterial stiffness is a determinant of cardiovascular disease in end stage renal disease. Hemodialysis patients may develop anti-platelet factor 4/heparin antibody (PF4-H Ab) because of heparin treatment in dialysis. We tested whether PF4-H Ab was associated with progression of arterial stiffness in a 3-year follow-up. METHODS: We enrolled 74 hemodialysis patients and studied their clinical, biochemical and arterial stiffness measurement with brachial-ankle pulse wave velocity (baPWV) over 3 years...
March 2017: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/28330422/bilateral-rectal-sheath-hematomas-after-low-molecular-weight-heparin-treatment-in-uremia
#7
Lu Xu, Lei Liu, Xinjian Li
Rectus sheath hematomas (RSHs) are uncommon. They are usually unilateral and rarely bilateral. In this paper, we report the first case of spontaneous bilateral RSHs in a uremic patient after the administration of the first dose of low-molecular weight heparin during hemodialysis. The most interesting aspect of this case is that the main symptom of RSH in our patient was urinary bladder irritation. We highlight the importance of the prompt diagnosis and management of this medical emergency.
November 2017: Renal Failure
https://www.readbyqxmd.com/read/28297060/drug-eluting-grafts-for-hemodialysis-access
#8
Marc Glickman
The development of new methods for drug elution of graft material, biofiber films and resurfacing of prosthetic graft surfaces offers new opportunities for improvement of graft function in arteriovenous (AV) access. Three areas of research include developing grafts that reduce the development of neointimal hyperplasia, reducing infection and reducing thrombogenicity. The only drug eluting graft presently being used, is the heparin coated expanded polytetrafluoroethylene (ePTFE) graft, which has been shown to decrease the incidence of early thrombosis...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28276631/antithrombotic-medications-in-dialysis-patients-a-double-edged-sword
#9
Georgios Vlachopanos, Farid Girgis Ghalli
In the clinical context of end-stage renal disease (ESRD), thrombosis and bleeding risks are simultaneously increased and may have devastating consequences. While anticoagulant and antiplatelet drugs are indispensable for the prevention of thromboembolic events, the significantly higher bleeding risk makes their handling extremely complicated. In ESRD, they are frequently administered for a wide array of conditions. For example, atrial fibrillation is quite common in ESRD and warrants the use of anticoagulants like warfarin...
February 2017: Journal of Evidence-based Medicine
https://www.readbyqxmd.com/read/28261626/influence-of-heparin-molecular-size-on-the-induction-of-c-terminal-unfolding-in-%C3%AE-2-microglobulin
#10
Kanon Fukasawa, Yuichiro Higashimoto, Yoshihiro Motomiya, Yoshinori Uji, Yukio Ando
Dialysis-related amyloidosis (DRA) is characterized by accumulation of amyloid β2- microglobulin (β2m) in the interstitial matrix. Matrix substances such as heparin have reportedly been strongly implicated in the pathogenesis of dialysis-related amyloidosis. In clinical setting of hemodialysis, two types of heparin, i.e., high and low molecular heparin (H.M.H. and L.M.H.) have been routinely used. Still commonly used is H.M.H., followed by L.M.H. preparations with distinct advantages. Here, we studied that the interaction of native and two amyloidogenic β2m variants: ΔN6β2m and D76N β2m with H...
December 2016: Molecular Biology Research Communications
https://www.readbyqxmd.com/read/28078825/ethanol-combined-with-heparin-as-a-locking-solution-for-the-prevention-of-catheter-related-blood-stream-infections-in-hemodialysis-patients-a-prospective-randomized-study
#11
Sofia Sofroniadou, Ioanna Revela, Alexandros Kouloubinis, Ioanna Makriniotou, Sinodi Zerbala, Despina Smirloglou, Petros Kalocheretis, Apostolos Drouzas, George Samonis, Christos Iatrou
Introduction Ethanol lock solution has been mainly administered in paediatric and home parenteral nutrition patients in order to prevent catheter related blood stream infections (CRBSI). Its utility in hemodialysis (HD) patients with non-tunneled-uncuffed catheter (NTC) has been poorly explored. Methods We conducted a prospective randomized study in chronic HD patients requiring a newly inserted NTC-while awaiting for the maturation of an already established arteriovenous fistula (AVF) or arteriovenous graft (AVG) or tunneled-cuffed catheter insertion...
January 11, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28073902/state-of-harmonization-of-24-serum-albumin-measurement-procedures-and-implications-for-medical-decisions
#12
Lorin M Bachmann, Min Yu, James C Boyd, David E Bruns, W Greg Miller
BACKGROUND: Measurements of serum and plasma albumin are widely used in medicine, including as indicators of quality of patient care in renal dialysis centers. METHODS: Pools were prepared from residual patient serum (n = 50) and heparin plasma (n = 48) from patients without renal disease, and serum from patients with kidney failure before hemodialysis (n = 53). Albumin was measured in all samples and in ERM-DA470k/IFCC reference material (RM) by 3 immunochemical, 9 bromcresol green (BCG), and 12 bromcresol purple (BCP) methods...
January 10, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28052124/prevalence-of-atrial-fibrillation-and-antithrombotic-therapy-in-hemodialysis-patients-cross-sectional-results-of-the-vienna-investigation-of-atrial-fibrillation-and-thromboembolism-in-patients-on-hemodialysis-vivaldi
#13
Oliver Königsbrügge, Florian Posch, Marlies Antlanger, Josef Kovarik, Renate Klauser-Braun, Josef Kletzmayr, Sabine Schmaldienst, Martin Auinger, Günther Zuntner, Matthias Lorenz, Ella Grilz, Gerald Stampfel, Stefan Steiner, Ingrid Pabinger, Marcus Säemann, Cihan Ay
BACKGROUND: Atrial fibrillation (AF) adds significant risk of stroke and thromboembolism in patients on hemodialysis (HD). The aim of this study was to investigate the prevalence of AF in a population-based cohort of HD patients and practice patterns of antithrombotic therapy for stroke prevention in AF. METHODS: The Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemodialysis (VIVALDI), an ongoing prospective observational cohort study, investigates the prevalence of AF and the risk of thromboembolic events in HD patients in Vienna, Austria...
2017: PloS One
https://www.readbyqxmd.com/read/28044236/vascular-adhesion-protein-1-in-hemodialysis-and-hemodiafiltration-patients-effect-of-single-hemodialysis-session-on-its-level-in-regard-to-type-of-anticoagulant
#14
Jolanta Malyszko, Ewa Koc-Zorawska, Piotr Kozminski, Jacek S Malyszko
PURPOSE: Traditional anticoagulants used in intermittent hemodialysis (HD) are unfractionated heparin (UFH) and increasingly low molecular weight heparins (LMWHs). Repeated and prolonged exposure to UFH and/or LMWHs may further disturb hemostasis in uremic patients. Vascular adhesion protein-1 (VAP-1) is secreted by vascular smooth muscle cells, adipocytes and endothelial cells with functional monoamine oxidase activity and is elevated in atherosclerosis, diabetes mellitus and obesity...
January 2, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28035620/does-antimicrobial-lock-solution-reduce-catheter-related-infections-in-hemodialysis-patients-with-central-venous-catheters-a-bayesian-network-meta-analysis
#15
Jun Zhang, Bo Wang, Rongke Li, Long Ge, Kee-Hsin Chen, Jinhui Tian
PURPOSE: The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial lock solutions (ALS) for prevention of catheter-related infections (CRI) in patients with hemodialysis (HD) and ranking these ALS for practical consideration. METHODS: We searched six electronic databases, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared ALS for preventing episodes of CRI in patients with HD either head-to-head or against control interventions using non-ALS...
April 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/27932155/late-allograft-renal-vein-thrombosis-treated-with-anticoagulation-alone-a-case-report
#16
C Ferreira, L Pereira, P Pereira, I Tavares, S Sampaio, M Bustorff, M Pestana
BACKGROUND: Allograft renal vein thrombosis is a rare complication of kidney transplantation. Most cases occur in the first 2 weeks after transplantation, but there are cases described many years after the transplant surgery. Allograft loss is the usual outcome. METHODS: We present a case of a renal transplant recipient with allograft renal vein thrombosis associated with deep venous thrombosis of a lower limb, 9 years after transplantation. He was successfully treated with anticoagulation alone, with recovery of allograft function...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27859427/citrate-buffered-dialysis-solution-citrasate-allows-avoidance-of-anticoagulation-during-intermittent-hemodiafiltration-at-the-cost-of-decreased-performance-and-systemic-biocompatibility
#17
Pavlina Richtrova, Jan Mares, Lukas Kielberger, Ladislav Trefil, Jaromir Eiselt, Tomas Reischig
Reportedly, citrate-based dialysis solution enables heparin dose tapering or even complete exclusion, particularly in postdilution hemodiafiltration (HDF). The aim of the study was to verify this strategy in predilution setting and to assess its short-term safety, efficacy, and biocompatibility. Ten regular hemodialysis patients were assigned to predilution HDF on acetate- and citrate-based dialysis solutions (0.8 mmol/l trisodium citrate) at random order. Acetate HDF was performed using routine dose of heparin while citrate HDF was heparin free...
November 10, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27734602/recurrent-heparin-induced-thrombocytopenia-due-to-heparin-rinsing-before-priming-the-machine-in-a-hemodialysis-patient-a-case-report
#18
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10(9) /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
April 2017: Hemodialysis International
https://www.readbyqxmd.com/read/27670267/the-clock-trial-a-double-blinded-randomized-controlled-trial-trisodium-citrate-30-and-minocycline-3-mg-ml-plus-edta-30-mg-ml-are-effective-and-safe-for-catheter-patency-maintenance-among-ckd-5d-patients-on-hemodialysis
#19
Marcus V S João Luiz, Cristoforo Scavone, Carmen Tzanno
INTRODUCTION: Poor blood flow rate (PF) is highly prevalent among CKD 5D patients with long-term central venous catheters. Heparin catheter lock solutions are commonly used to maintain catheter patency, however the incidence of PF remains high. The purpose of the CLOCK Trial was to evaluate two catheter lock solutions on reduction of PF incidence. METHODS: Seventy-five CKD 5D patients on high-efficiency hemodialysis at the Integrated Centre of Nephrology (Guarulhos, Brazil) were randomized 1:1:1 to receive a lock solution combining minocycline 3 mg/mL with the anticoagulant/chelation agent EDTA 30 mg/mL (M-EDTA) or heparin 1000 IU/mL (H) or trisodium citrate 30% (TSC) vs...
April 2017: Hemodialysis International
https://www.readbyqxmd.com/read/27670146/three-cases-of-spontaneous-lumbar-artery-rupture-in-hemodialysis-patients
#20
Na Kyoung Hwang, Harin Rhee, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Chang Won Kim, Sang Heon Song
We encountered three cases of retroperitoneal hematoma caused by spontaneous lumbar artery rupture, a rare vascular complication. At the time of retroperitoneal hematoma, two patients were on anticoagulant/antiplatelet therapy. One patient was not taking any anticoagulant/antiplatelet agents but was receiving hemodialysis treatment with heparin. Lumbar artery rupture was successfully controlled by transcatheter arterial embolization in all patients, but one patient developed multiple organ failure and died...
September 26, 2016: Hemodialysis International
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