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Hemodiyaliz Hastalarında Standart Heparin ve Düşük Moleküler Ağırlıklı Heparinin Lipid Profili ve C-Reaktif Protein Üzerine Etkilerinin Karşılaştırılması

The Comparison of Effects of Standard Heparin and Low Molecular Weight Heparin on Lipid Profile and C-Reactive Protein in Hemodialysis Patients

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2005

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Lipid disorder is a well-known problem in hemodialysis (HD) patients. This condition is an important risk factor for cardiovascular disease. Although a positive effect of l ow molecular weight heparin (LMWH) upon lipid profile has been proposed in HD patients, this consequence is still controversial. Furthermore, HD patients are exposed to chronic inflammation that is also known as a risk factor for cardiovascular disease. In this study, we compared the effect of LMWH and standard heparin (SH) on lipid profile and Creactive protein that is one of the inflammation markers. In this prospective, randomized, and cross-over study, 30 HD patients were enrolled in the study. They were randomly divided into two groups. SH was administered to group I and LMWH was administered to group II. Blood samples were drawn before HD sessions at the beginning, eight weeks before and after switching the therapy. The study was finished at the sixteenth week. Lipid profile, high sensitivity-CRP and albumin were determined. Serum lipid parameters and serum albumin levels, which we¬ re determined at the beginning, before and after switching the the¬ rapy, were not significantly changed (p>0.05). However, CRP was significantly reduced in patients treated with LMWH before and af¬ ter switching therapy (p<0.05). Neither LMWH nor SH has an effect upon serum lipid and albumin levels. More than two months may be required to cause significant changes in lipid profile and serum albumin levels in HD patients. However, we demonstrated a decrease in the inflammation, which is responsible for the cardiovascular morbidity and mortality, independently from the serum lipid and albumin levels. Although long-term studies are warranted, our results indicate that LMWH should be preferred for anticoagulation in HD patients due to its beneficial effects upon inflammation.
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Abstract (Original Language): 
Hemodiyaliz (HD) hastalarında lipid profilinde bozulma olduğu bilinmektedir. Bu durum kardiyovasküler hastalık açısından önemli bir risk faktörüdür. Düşük moleküler ağırlıklı heparinin (DMAH) HD hastalarında serum lipid profili üzerine olumlu etkileri olduğu ileri sürülmesine rağmen, bu konu halen tartışmalıdır. Ayrıca HD hastalarında kronik bir inflamasyon olduğu ve bunun da kardiyovasküler hastalık açısından bir risk faktörü ol¬ duğu bilinmektedir. Bu çalışmada, DMAH'nin ve standart heparinin (SH) lipid profili üzerine ve inflamasyon parametrelerinden biri olan C-reaktif protein (CRP) üzerine olan etkileri, ileriye dönük, çapraz değişimli olarak karşılaştırıldı. ileriye dönük, rasgele yöntemli, çapraz değişimli çalışma olarak tasarlanmış olan bu çalışmada, çalışma şartlarına uygun 30 kronik hemodiyaliz hastası alındı. Hastalar rasgele yöntemle 15'er kişilik iki gruba ayrıldı. Grup I'deki hastalara SH, grup Il'deki hastalara ise DMAH (dalteparin) verildi. Hastalar 16 hafta boyunca takip edildi. Çalışmanın başlangıcında, sekizinci haftanın sonunda tedavi rejimi değiştirilmeden önce ve takip eden sekiz hafta sonra her iki gruptan diyalizden hemen önce kan örnekleri alınarak on altıncı hafta sonunda çalışma bitirildi. Lipid profili ile birlikte yüksek duyarlılıklı CRP ve albümin değerlendirildi. Başlangıçta, tedavi rejimi değiştirilmeden hemen önce ve değiştiril¬ dikten sonra değerlendirilen lipid parametrelerinde ve serum albümin se¬ viyelerinde istatistiksel olarak anlamlı bir değişim gözlenmezken (p>0.05), değişim öncesi ve değişim sonrasında DMAH kullanılan olgularda CRP istatistiksel olarak anlamlı azalma gösterdi (p<0.05). HD hastalarında iki aylık süre içinde lipid profiline etki açısından SH ile DMAH arasında fark gözlenmedi. Ancak lipid profilindeki ve albümin seviyelerindeki değişimden bağımsız olarak kardiyovasküler morbiditeden ve belki de mortaliteden sorumlu olan inflamasyon, DMAH ile anlamlı olarak azalmıştır. Daha uzun dönemli çalışmaların yapılması gerekmekle birlikte, lipid parametrelerinde değişim olmaksızın inflamasyonda gözlenen olumlu etkisini göz önünde bulundurduğumuzda, antikoagülasyonun zorunlu olduğu HD'de DMAH'lerin SH'ye oranla daha avantajlı olduğu ifade edilebilir.
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  • 2
65-70
  • Turkish

REFERENCES

References: 

1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal failure. Am J Kidney Dis 1998;32(Suppl 5):112-119.
2. Attman P, Samuelsson O, Johansson A, Moberly JB. Dialysis modalities and dyslipidemia. Kidney Int 2003;63(Suppl 84), 110-112.
3. Stenvinkel P, Alvestrand A. Inflammation in end stage re¬nal disease: sources, consequences, and therapy. Semin Dial 2002;15:329-337.
4. Ross R. Atherosclerosis: An inflammatory disease. N Eng J
Med 1999;340:115-126.
5. Stenvinkel P. Inflammatory and atherosclerotic interactions in the depleted uremic patient. Blood Purif 2001;19:1953-
1961.
6. Stenvinkel P. Endothelial dysfunction and inflammation- is there a link? Nephrol Dial Transplant 2001;16:1968-1971.
7. Wiemer J, Winkler K, Baumstark M, Marz W, Scherberich JE. Influence of low molecular weight heparin compared to conventional heparin for anticoagulation during hemodi-alysis on low density lipoprotein subclasses. Nephrol Dial
Transplant 2002;17:2231-2238.
8. Deuber HJ, Schulz W. Reduced lipid concentrations during four years of dialysis with low molecular weight heparin.
Kidney Int 1991;40:496-500.
9. Kronenberg F, Konig P, Lhotta K, Steinmetz A, Dieplinger H. Low molecular weight heparin does not necessarily re¬duce lipids and lipoproteins in hemodialysis patients. Clin Nephrol 1995;45:399-404.
10. Kronenberg F, Konig P, Neyer U, et al. Influence of various heparin preparations on lipoproteins in hemodialysis pati¬ents: a multicenter study. Thromb Haemost 1995:74:1025¬1028.
11. Ma KW, Grene EL, Rau L. Cardiovascular risk factors in chronic renal failure and hemodialysis populations. Am J
Kidney Dis 1992;19:505-514.
12. Mathur S, Devaraj S, Jialal I. Accelerated atherosclerosis, dyslipidemia, and oxidative stress in end-stage renal dise¬ase. Curr Opin Nephrol Hypertens 2002;11(2):141-147.
13. Massy ZA, Kassiki BL. Hyperlipidemia and its management in renal disease. Curr Opin Nephrol Hypertens 1996;5:141-
146.
14. Castelli WP, Garrison WJ, Wilson WF, Abbott RD, Kalous-
dian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels: The Framingham Study.
JAMA 1986;256:2835-2838.
15. Martin MJ, Hulley SB, Browner WS, Kuller LH, Wenthworth
D. Serum cholesterol, blood pressure, and mortality: implica¬tions from a cohort of 361.662 men. Lancet 1986;2:933-936.
16. Street A, McPherson J. The new heparins. Aus Prescriber
1996;19:104-108 (abstract).
17. Persson E, Nordenstrom J, Nilsson-Ehle P, Hagenfeldt L. Li-polytic and anticoagulant activities of a low molecular we¬ight fragment of heparin. Eur J Clin Invest 1985;15:215-220.
Official Journal of the Turkish Society of Nephrology / Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
69
£ The Comparison of Effects of Standard Heparin and Low Molecular Weight Heparin in Hemodialysis Patients
18. Schmitt Y, Schneide H. Low molecular weight heparin: inf¬luence on blood lipids in patients on chronic haemodialy-
sis. Nephrol Dial Transplant 1993;8:438-442.
19. Berström J, Heimbürger O, Lindholm B, Qureshi AR. Eleva¬ted serum C-reactive protein is a strong predictor of incre¬ased mortality and low serum albumin in haemodialysis pa¬tients. J Am Soc Nephrol 1995;6:573 (Abstract).
20. Stenvinkel P. Inflammation in end stage renal failure: could
it be treated? Nephrol Dial Transplant 2002;(Suppl 8):33-38.
21. Tsirpanlis G, Chatzipanagiotou S, Nicolaou C. Microinflam-mation versus inflammation in chronic renal failure pati¬ents. Kidney Int 2004; 2093-2094.
22. Kaysen GA, Dublin JA, Müler HG, Rosales LM, Levin NW.
The acute phase response varies with time and predicts se¬rum albumin levels in hemodialysis patients. Kidney Int
2000; 58:346-352.
23. Stenvinkel P, Heimburger O, Paultre F, et al. Strong associ¬ation between malnutrition, inflammation and atheroscle¬rosis in chronic renal failure. Kidney Int 1999;55(5):1899-
1911.
24. Panichi V, Migliori M, De Pietro S, et al. C-reactive protein
in patients with chronic renal diseases. Renal Failure
2001;23: 551-562.
25. Griselli M, Herbert J, Hutchinson WL, et al. C- reactive protein and complement are important mediators of tissue damage in acute myocardial infarction. J Exp Med 1999;190:1733-1739.
26. Bhakdi S,Torzewski M, Klouche M, et al. Binding of CRP to
degraded, non-oxidized LDL enhances complement activa¬tion. Arterioscler Thromb Vasc Biol 1999;19:2348-2354.
27. Keane WF, Collins AJ. Influence of co-morbidity on morta¬lity and morbidity of hemodialysis patients. Am J Kidney
Dis 1994;24:1010-1018.
28. Lowrie EG, Lew NL. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities.
Am J Kidney Dis 1990;15:458-482.
29. Qureshi AR, Alvestrand A, Danielsson A, et al. Factors inf¬luencing malnutrition in hemodialysis patients: a cross sec¬tional study. Kidney Int 1998;53:773-782.
30. Kaysen GA, Stevenson FT, Depner TA. Determinations of albumin concentration in hemodialysis patients. Am J Kid¬ney Dis 1997;29:658-668.

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