Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study

Abstract

Background: Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of osteoporotic fracture has been shown for many years. However, this association was not as clear for low-molecular-weight heparin (LMWH) and the few collected data originated from studies among pregnant women. Our aim was to measure osteoporotic fracture rate among hemodialysis patients and to evaluate the association of LMWH compared to UFH in hemodialysis. Methods: A retrospective cohort study was conducted on data extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 with patients chronically hemodialyzed in 21 participating centers. Incidence rates for each fracture sites were measured per 1000 patient-year (p-y) and their 95% confidence intervals (CI). Osteoporotic fracture risk for a first event with LMWH compared to UFH was estimated using a cox proportional hazard model using demographics, comorbidities and drug use as covariates. Results: 4796 patients undergoing chronic hemodialysis were identified. The incidence rate for all fracture sites was 22.7 /1000 p-y (95%

HEMA-Lysine-Based Cryogels for Highly Selective Heparin Neutralization

“…In all of these cases, the anticoagulant effect of the administered heparin must be controlled and, if necessary, neutralized to prevent fatal bleeding events. Dialyzed people routinely use heparin during each dialysis session, several times a week and without any neutralization, so the accumulation of unmetabolized drugs often causes the onset of severe complications like heparin-induced thrombocytopenia (HIT) [ 2 ], osteoporosis [ 3 ], and other effects on metabolism such as hyperlipidemia. To date, protamine sulfate, a low-molecular-weight arginine-rich protein, is the only approved antidote to neutralize UFH [ 4 ].…”

Single-Bolus Tinzaparin Anticoagulation in Extended Hemodialysis Session: A Feasibility Study

“…2 , 7 , 8 Use of LMWH anticoagulation for HD has been associated with positive effect on lipid profile and possibly improved cost-effectiveness without increasing bleeding risk. 7 – 10 Equipoise persist in regard to osteoporosis with studies showing similar 11 , 12 or reduced 13 risk with LMWH compared with UFH.…”