Review article: Low‐molecular‐weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments

Davenport, Andrew

doi:10.1111/j.1440-1797.2009.01135.x

Cited by 112 publications

(126 citation statements)

References 18 publications

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“…All patients were dialysed with Fresenius 4008 machines and polysulphone dialysers (Fresenius, Bad Homberg, Germany), with a dialysate flow of 800 ml/min, and administered low-molecular-weight heparin (Tinzaparin, Leo Laboratories, Denmark) as a venous bolus [14]. The HDF component of treatment ranged from 60–85 ml/min, with an average of >16 litres exchanged per treatment session (table 1).…”

Section: Methods and Patientsmentioning

confidence: 99%

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

2011

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Introduction: Intradialytic hypotension remains the commonest complication of outpatient haemodialysis (HD) treatments. On-line haemodiafiltration (HDF) has been reported to reduce the frequency of intradialytic hypotension. We introduced on-line HDF into our satellite dialysis program, and prospectively audited the effect of HDF on cardiovascular stability. Methods: 34 patients’ dialysis schedules (Tuesday/Thursday/Saturday) were converted to online post-dilutional HDF, and 44 patients’ dialysis schedules (Monday/Wednesday/Friday) remained on high-flux HD. Blood pressure and intra-treatment complications were monitored prospectively for 12 months. Results: There was no significant change in pre-treatment mean arterial blood pressure in the HDF group during the 12 months of the study (pre-treatment 113.7 ± 0.7 mm Hg vs. 109.3 ± 2.8 after 12 months), or for the HD cohort (113.9 ± 2.7 vs. 117.9 ± 2.6). However, the frequency of intradialytic hypotensive episodes was greater for the HDF cohort: 25.9 versus 16.5% in the HD cohort, p = 0.0116. During HDF, on average >16 litres of substitution fluid was used and the median temperature was 36°C (35°C–36°C), higher than the dialysate in the HD cohort which was 35°C (35°C–36°C), p < 0.05. Conclusion: In this study, HDF did not improve blood pressure control or reduce the frequency of intradialytic hypotensive episodes compared to high-flux HD using cooled dialysate.

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Section: Methods and Patientsmentioning

confidence: 99%

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

2011

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“…All patients dialysed with Fresenius 4008 machines and polysulphone dialyzers (Fresenius, Bad Homberg, Germany) (table 1), with a dialysate flow 800 ml/min, and anticoagulated with tinzaparin (Leo Laboratories, Princes Risborough, UK) administered as a venous bolus [16]. The haemodialfiltration component of treatment ranged from 60 to 85 ml/min, with an average of >16 litres exchanged per treatment session.…”

Section: Methodsmentioning

confidence: 99%

Haemodiafiltration versus High-Flux Haemodialysis: Effects on Phosphate Control and Erythropoietin Response

2010

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Introduction: Haemodiafiltration (HDF) has been reported to improve erythropoietin (EPO) responsiveness and phosphate clearance. We prospectively audited the effect of HDF on EPO dosages, weight and serum phosphate. Methods: 34 patients dialyzing on Tu/Th/Sa switched to HDF, and 44 dialyzing on M/W/F remained on high-flux haemodialysis (HD) and were followed for 12 months. Results: Dialysis adequacy (Kt/V start HDF 1.56 ± 0.03 vs. HD 1.58 ± 0.04 and 12 months 1.55 ± 0.03 vs. 1.59 ± 0.03), haemoglobin (start 11.7 ± 0.3 vs. 11,8 ± 0.2 g/dl and end 11.5 ± 0.1 vs. 11.3 ± 0.3 g/dl), weight (start 69.8 ± 2.4 vs. 67.8 ± 2.5 kg and end 67.4 ± 2.5 vs. 66.1 ± 2.3 kg), or EPO prescription (start 83 (61–186) vs. 123 (71–225) IU/kg/weeks and 12 months 142 (48–188) vs. 124 (59–223) IU/kg/weeks) did not differ. There were no differences in serum albumin, CRP, calcium and parathyroid hormone. Serum beta-2-microglobulin (B₂M) decreased with HDF (32.7 ± 1.9 vs. 28.1 ± 1.1 mg/l, p < 0.01), but not with HD (31.6 ± 1.4 vs. 31.5 ± 1.1 mg/l). Serum phosphate fell with HDF (start 1.48 ± 0.08 vs. 1.57 ± 0.07 mmol/l (p = NS); 3 months 1.35 ± 0.07 vs. 1.61 ± 0.08; 6 months 1.34 ± 0.06 vs. 1.57 ± 0.06, and 12 months 1.36 ± 0.07 vs. 1.67 ± 0.07, all p < 0.05). Conclusion: HDF did not lead to weight gain or improved EPO responsiveness in this prospective observational study. However, predialysis serum phosphate and B₂M fell with HDF.

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“…Patients were followed up for a median of 14 months (range, 9.5–22.5). All patients used the low-molecular-weight tinzaparin (Leo Laboratories, Copenhagen, Denmark) for anticoagulation [10]. All patients dialyzed using a 4008 dialysis machine (Fresenius, Bad Homberg, Germany) with integrated on-line clearance and thermodilution vascular access recirculation modules.…”

Section: Patients and Techniquementioning

confidence: 99%

Patients’ Perspectives of Constant-Site (Buttonhole) Cannulation for Haemodialysis Access

2010

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Introduction: The advent of blunt needles for arteriovenous fistula cannulation has led to a resurgence in the buttonhole technique. Although successful for home haemodialysis patients and those who self-cannulate, we introduced this technique into one of our satellite dialysis centres. Methods: Audit of buttonhole cannulation in 53 adult haemodialysis patients, 29 male, mean age 68.5 ± 1.9 years. Twelve (23%) patients started de novo and 41 (77%) had previously been using sharp needles with the rope ladder technique. Results: Typically, the needle tract was developed after 8–10 cannulations depending on the tracker nurse and vessel. Ninety-three percent of the patients reported shorter venepuncture bleeding times after needle removal, 81% less pain on needling and 80% improved appearance of the fistula compared to sharp needle rope ladder technique. Fistula recirculation rates fell from 9.3 ± 0.4 to 8.3 ± 0.3% (p = 0.016), as did fistuloplasty requirement during a median follow-up of 14 months (range, 9.5–22.5; χ² = 5.6, p = 0.008). Conclusions: Buttonhole cannulation can be successfully introduced into a busy satellite dialysis centre. Patient satisfaction improved due to lower pain scores, shorter bleeding times after needle removal and improved appearance of the fistula. Recirculation rates and requirement for fistuloplasty were also reduced.

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Review article: Low‐molecular‐weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments

Cited by 112 publications

References 18 publications

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

Haemodiafiltration versus High-Flux Haemodialysis: Effects on Phosphate Control and Erythropoietin Response

Patients’ Perspectives of Constant-Site (Buttonhole) Cannulation for Haemodialysis Access

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