[Antithrombotic activity of low molecular weight heparin (enoxaparin) during hemodialysis in patients with terminal kidney failure]. / Przeciwzakrzepowe dzialanie niskoczasteczkowej heparyny (enoksaparyny) w czasie hemodializy u pacjentów ze schylkowa niewydolnoscia nerek.

The aim of the study was to evaluate the efficacy of low molecular weight heparine (enoxaparin) in comparison to heparin during haemodialysis (HD) in prevention of blood clotting chestry extracorporeal circulation. Enoxaparin (Clexan, Rhone-Poulenc Rorer, in syringes, 20 mg) was evaluated in 42 patients with end stage renal failure treated with HD. In the first part of study heparine and in the second part enoxaparin given into arterial lines were evaluated during 6 following HD with the same type of dialysator. Clotting of extracorporeal circulation and bleeding time from the needle site after HD were evaluated. Activated partial thromboplastin time (APTT) before, after 1 hour of HD and after HD during heparine and enoxaparin were measured. There was advantage of enoxaparin in 23 patients when compared to heparine. It was depended on the reduction of number of injections of enoxaparin when compared to heparine (22 patients have received heparine in 2 or more doses when only 5 patients have received enoxaparin in 2 doses) on the reduction of clotting events in extracorporeal circulation (16 events during heparine treatment -6.3% of all HD and 5 events during enoxaparin treatment -2.0% of all HD), and on the shortening of the bleeding time from the needle site after HD (5.9 +/- 3.4 min. during heparin and 4.5 +/- 1.6 min. during enoxaparin treatment; p < 0.02). Increase of APTT after 1 hour of HD when compared to the value from before HD was significantly lower during enoxaparin than heparine therapy (1.73 +/- 0.4 and 2.55 +/- 0.91 respectively; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of bone mineralization in patients on maintenance hemodialysis]. / Ocena mineralizacji tkanki kostnej u chorych leczonych powtarzalnymi hemodializami.

Bone loss and bone formation and mineralization abnormalities resulting from disturbances in calcium and phosphorus metabolism are frequent in chronic renal failure. Haemodialysis permits long-term survival of patients with end-stage renal disease. This is the reason, why renal osteodystrophy became an important diagnostic and therapeutical problem. Very low occurrence of fractures among haemodialysed patients in our clinic, stimulated our efforts to elucidate the causes of this phenomenon. The aim of this study was to compare bone mineral densities in haemodialysed patients and healthy volunteers. 47 patients on maintenance haemodialysis (16 F, 31 M) and 55 healthy volunteers (33 F, 22 M) with normal renal function were investigated. Endocrinopathy or any other diseases that could cause changes in bone metabolism were excluded. Age distribution in both groups was similar. Patients maintained on low sodium and phosphorus diet additionally were supplemented with large doses of calcium carbonate. Haemodialyses were performed using reverse-osmosis water. BMD (Bone Mineral Density) was measured using QCT (Quantitative Computed Tomography) and was expressed as an average hydroxyapatite content in lumbar vertebraes L1-L4. The obtained results indicate high BMD of vertebral bones in haemodialysed patients from our Dialysis Department. BMD was similar to that observed in healthy volunteers. This could at least partially explain low occurrence (2 in 142 pts-years) of fractures in ou uraemic patients. However we were unable to point exactly the simple factor responsible for this positive phenomenon. We hope that introduction of our haemodialysis scheme can help patients to avoid renal osteodystrophy.