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NDT Advance Access published online on February 19, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh065
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received September 12, 2003
Accepted November 26, 2003

Original Article

Intraperitoneal heparin reduces peritoneal permeability and increases ultrafiltration in peritoneal dialysis patients

Jonas Angel Sjøland 1*, Robert Smith Pedersen 2, Jørgen Jespersen 1, Jørgen Gram 1

1 Department of Clinical Biochemistry; Department for Thrombosis Research, University of Southern Denmark, Denmark
2 Department of Nephrology, Ribe County Hospital in Esbjerg/Varde, Denmark

* To whom correspondence should be addressed. E-mail: jasj{at}ribeamt.dk.



  Abstract

Background. Patients on long-term treatment with peritoneal dialysis (PD) suffer from increasing peritoneal permeability and loss of ultrafiltration as a result of persistent inflammation, which may be triggered by bioincompatible dialysis fluids. Heparins have anti-inflammatory and anticoagulant properties. We have examined the effect of intraperitoneal (IP) low-molecular weight heparin (tinzaparin) on peritoneal permeability and ultrafiltration in PD patients.

Methods. By means of a double-blinded cross-over design, 21 PD patients were randomized to receive either placebo or tinzaparin intraperitoneally once a day for two treatment periods of 3 months, separated by a wash-out period. The effect of heparin on peritoneal permeability and ultrafiltration was assessed using the 4 h standard peritoneal equilibration test.

Results. IP tinzaparin reduced significantly the dialysate-to-plasma ratios (D/P) of creatinine (P < 0.01), urea (P < 0.01) and albumin (P<0.05). In addition, the ratio of glucose concentration in dialysate at 4 h dwell to that of 0 h dwell (D4/D0) was increased (P<0.05) along with an increase in ultrafiltration volume (P<0.05).

Conclusions. IP tinzaparin reduces peritoneal permeability to small solutes and increases ultrafiltration in PD patients.

Keywords: heparin, intraperitoneal administration, peritoneal dialysis, peritoneal transport, ultrafiltration


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