Nephrology Dialysis Transplantation, Vol 12, Issue 12 2638-2646, Copyright © 1997 by Oxford University Press
H Sperschnieder, R Deppisch, W Beck, H Wolf and G Stein
Background: We reasoned that procoagulant activity,
and by implication heparin requirement, during haemodialysis are
influenced, amongst other factors, by the type of membranes and the
geometry of the blood line system. In addition, there are indications that
heparin has dose-dependent effects on the lipid status of chronic
haemodialysis patients. Methods: In a parallel group
design we compared patients treated with cuprophane (CU) and
polycarbonate-polyether (PC-PE) plate dialysers. In both groups, blood line
geometry was varied by including in a first phase and omitting in a second
phase drip chambers in the arterial blood line. End-points were changes in
coagulation parameters, i.e. thrombin-antithrombin III complex (TAT),
plasmin-anti-plasmin complex (PAP), and prothrombin fragment (F1+2)
concentrations measured by sandwich ELISA. Subsequently all patients were
switched to PC-PE dialysers for 6 months and the heparin dose was reduced
in a stepwise fashion. Lipid levels and coagulation parameters were
monitored. Finally, in an ancillary study, the correlation between heparin
dose and LDL/HDL ratio was assessed in patients chronically exposed to
PC-PE membranes and low doses of heparin. Results:
Post-dialytic concentrations of coagulation and fibrinolysis parameters
were significantly lower in the PC-PE group (TAT 21.0±4.4
&mgr;g/l; PAP 1180±1148 &mgr;g/l; F1+2
4.2±0.4 nmol/l) compared to the CU group (TAT
57.3±10.8 &mgr;g/l; PAP 1789±185 &mgr;g/l;
F1+2 8.8±1.0 nmol/l), independently of the use of an arterial
drip chamber. Omission of the arterial drip chamber led to lower TAT in the
CU group (42.2±5.8 &mgr;g/l, P <0.05), but not in the
PC-PE group. In contrast, PA and F1+2 concentrations did not change
significantly in either group. Down-titration of heparin dose (from
20.4±1.1 to (9.4±0.9 IU/kg/h) was associated with a
significant decrease in serum triglycerides (from 2.9±0.9 to
2.0±0.6 mmol/l, P <0.05), LDL-cholesterol (from
3.4±0.2 to2.7±0.4 mmol/l, P <0.05) and
LDL/HDL-ratio (from 3.2±0.3 to 2.0±0.3, P
<0.05) with no significant change of total or HDL-cholesterol after
6 months. In an ancillary analysis, a correlation between lipid parameters
(LDL/HDL ratio) and heparin dose was confirmed in 24 patients chronically
exposed to PC-PE membranes (r=0.473, P <0.05).
Conclusions: In a prospective exploratory study (I)
heparin requirement is lower with the use of a polycarbonate-polyether
membrane compared to a cuprophane membrane, (ii) heparin requirement is
influenced by blood line geometry (decreased with omission of an arterial
drip chamber), and (iii) in patients on polycarbonate-polyether membranes
down-titration of heparin is associated with a reduction of serum
triglycerides, LDL cholesterol, and LDL/HDL ratio. Our data suggest that
reduction of heparin dose improved lipid profile. These preliminary
observations require confirmation by parallel group controlled studies with
controlled dietary intake. Key words: atherogenesis;
coagulation; haemodialysis; heparin; lipid disorders; membranes
ORIGINAL ARTICLES
Impact of membrane choice and blood flow pattern on coagulation and heparin requirement - potential consequences on lipid concentrations
Department of Internal Medicine, University of Jena, Germany; Gambro Group Renal Care R& D, Hechingen, Germany; Corresponding author at: Klinik fur Innere Medizin, Innere Medizin IV, Erlanger Allee 101, D-07740 Jena, Germany
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