Hemodialysis and Heparin: A Dangerous Mixture to Avoid?

Mayo Clinic researchers searching for explanations of high mortality rates among kidney-failure patients undergoing hemodialysis are focusing their attention on the use of heparin, a drug used to reduce clotting of the blood.

Their study in the August issue of Mayo Clinic Proceedings is a preliminary look at one aspect affecting the health of patients who undergo hemodialysis. In the study, they found patients who had a higher level of adverse outcomes also had elevated levels of heparin antibodies in their blood. The authors believe this is the first study examining this association.

However, Robert McBane, M.D., a Mayo Clinic cardiovascular-disease specialist who led the study, cautions that these results are preliminary.

Heparin is an anticoagulant, which is usually used to prevent the formation of blood clots in the blood vessels that can prove harmful. For patients with end-stage renal disease (kidney failure), hemodialysis is the most common form of therapy. Recent figures show more than 85 percent of the approximately 379,000 patients with the disease were treated this way.

In hemodialysis, a patient's blood is passed through a machine to clean it, similar to what the kidneys might do if the body was functioning normally. Heparin must be used to prevent clotting of the blood in the dialysis machine in order to safely perform hemodialysis. The results of this analysis, if confirmed by others, might stimulate the search for better anti-coagulants that can be used in hemodialysis.

In an editorial in the same issue, Dr. Donald Arnold and Dr. John Kelton of the department of medicine at the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ontario, say the study adds to the evidence that the heparin antibodies may be an indicator of problems.



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