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Abstract: SA-PO1023

Coagulation and Circulating Heparin Profile in Patients with ESRD Undergoing Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

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

Unfractionated heparin is widely used as an anticoagulant for maintenance hemodialysis in end-stage renal disease (ESRD) patients. Since these patients are administered with heparin repeatedly throughout treatment, it is hypothesized that detectable circulating levels of heparin may be present in their blood 48 hours post-dialysis session. The profiling of these parameters may provide the hemostatic status of patients in reference to circulating residual heparin in the pre-dialysis blood samples.

Methods

This study included 95 patients with ESRD undergoing maintenance hemodialysis, which was administered 3 times per week in 48-hour intervals. Plasma samples were analyzed utilizing clot-based methods including activated partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin time (TT). Employing a chromogenic assay, the circulating levels of heparin in each patient were measured. All of these samples were also analyzed for thrombin generation capacity using calibrated automated thrombogram (CAT, Diagnostica Stago. Paris, France).

Results

In the clotting assays, prothrombin time was elevated (16.4±20.3 sec.) in comparison to the normal control (11.1±2.1 sec.;p<0.05). Activated partial thromboplastin time was also prolonged (43.09±43.1 sec.) when compared to normal human plasma (32.3±4.2sec.;p<0.05). The thrombin time values were markedly higher (44.6±83.1 sec.) in comparison to normal (11.2 ±2 sec.;p<0.001). Circulating heparin levels, measured by anti-Xa methods, were found to be 0.11± 0.21 U/ml and anti-IIa levels being 0.25±0.27 U/ml;(p<0.05). In the thrombin generation assay, the ESRD samples showed wide variation and a lowered thrombin generation value (107±55.2 nM) in comparison to normal control (185±16.5 nM;p<0.05).

Conclusion

These results suggest patients undergoing maintenance hemodialysis exhibit a mild hypo-coagulable state as determined by PT and aPTT methods. The circulating levels of heparin were lower in anti-Xa compared to anti-IIa, suggesting the presence of higher molecular weight components of circulating heparin.
These studies suggest that ESRD patients on maintenance hemodialysis exhibit a hypocoagulable state in which circulating residual heparin may contribute to the overall hemostatic deficit.