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Abstract: SA-PO1024

Measurement and Characterization of Circulating Heparin in Heparin-Naive ESRD Patients on Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bajwa, Jasdeep S., University of Rochester, Mississauga, Ontario, Canada
  • Bansal, Vinod K., Loyola University Medical Center, Maywood, Illinois, United States
  • Grewal, Arjun Singh, Loyola University Chicago, Wauconda, Illinois, United States
  • Hoppensteadt, Debra, Loyola University Medical Center, Maywood, Illinois, United States
  • Bontekoe, Emily, Loyola University Chicago, Wauconda, Illinois, United States
  • Siddiqui, Fakiha, Loyola University Chicago, Wauconda, Illinois, United States
  • Fareed, Jawed, Loyola University Medical Center, Maywood, Illinois, United States
Background

In a cohort of 95 ESRD patients undergoing maintenance hemodialysis, 30 patients did not receive any exogenous heparin during their routine dialysis sessions. However, these patients showed an increase in their PTT, anti-Xa, and anti-IIa assays which were neutralized upon heparinase treatment indicating the presence of endogenous heparin. The objective of this study is to quantify and characterize the heparin in this cohort of the ESRD patients.

Methods

Thirty heparin-naïve patients were identified through a chart review. Pre-dialysis blood samples collected from these patients were centrifuged to obtain plasma which was frozen at
-70°C. These samples were thawed in batches and each sample was divided into two equal volumes; one sample was supplemented with saline while the other was mixed with a heparin digesting enzyme (Heparinase-1). These samples were analyzed for aPTT using a clot-based assay, amidolytic anti-Xa, and anti-IIa assays using specific chromogenic substrates. The test results were compiled as group mean +/- 1SD.

Results

The results collected from these patients showed an average PTT in the pre-Heparinase sample of 36.5 +/- 24.8, which decreased to 30.9 +/- 5.5 in the post-Heparinase samples (P=0.224). Anti-Xa and Anti-IIa are markers used in the study to demonstrate Heparin activities – a decrease upon Heparinase treatment in these activities confirms the presence of circulating Heparin. The average Anti-Xa in pre and post-Heparinase were 0.08 +/- 0.15 and 0.02 +/- 0.07 (P<0.05), whereas the average Anti-IIa in pre and post-Heparinase were 0.24 +/- 0.30 and 0.13 +/- 0.12, (P<0.05). These results indicate there was heparin activity present in the pre-Heparinase samples, but that activity was reduced in the post-Heparinase samples.

Conclusion

These findings demonstrate that there is endogenous heparin present in these heparin naïve patients. It has been hypothesized that endogenous heparin in these patients may have originated from endothelial sites. The shedding of heparin from endothelium may reflect endothelial dysfunction which has been reported in ESRD patients and may be correlated the severity of the pathogenesis of ESRD.