Related Experiment Videos
Is heparin therapy necessary in CAPD peritonitis?
C Nadig1, U Binswanger, A von Felten
1Department of Nephrology, University Hospital, Zurich, Switzerland.
Insights
Routine heparin therapy for continuous ambulatory peritoneal dialysis (CAPD) peritonitis is not necessary. Low D-dimer levels in CAPD dialysate during peritonitis may indicate a need for heparinization in rare cases.
Area of Science:
- Nephrology
- Peritoneal Dialysis
- Inflammation Research
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) peritonitis management often includes heparin therapy.
- Hospitalization for heparin therapy in CAPD peritonitis is costly.
- Evidence supporting the routine use of heparin in CAPD peritonitis is lacking.
Purpose of the Study:
- To evaluate the necessity of routine heparin therapy in patients with CAPD peritonitis.
- To investigate the role of coagulation and fibrinolysis markers in CAPD peritonitis.
Main Methods:
- Analysis of 194 peritoneal dialysate samples from 17 patients over 24 months.
- Categorization of samples into no, mild, and severe peritonitis groups based on leukocyte counts.
- Measurement of leukocytes, total protein, thrombin-antithrombin III (TAT) complexes, D-dimers, and plasminogen activator inhibitor 1 (PAI-1).
Main Results:
- Dialysate protein, TAT-complex, and D-dimer concentrations increased with peritonitis severity.
- A strong correlation was observed between TAT-complex and D-dimer concentrations.
- In a subset of patients with peritonitis, high PAI-1 and low D-dimer levels indicated blocked fibrinolysis.
Conclusions:
- Routine intraperitoneal heparin administration is not required for CAPD peritonitis.
- Rare cases of peritonitis with blocked fibrinolysis (high PAI-1, low D-dimer) may benefit from heparinization.
- Low D-dimer levels in CAPD dialysate during peritonitis can identify patients who might require heparin therapy.
Objective:
Heparin therapy in continuous ambulatory peritoneal dialysis (CAPD) peritonitis seems well established; it is costly due to the necessity of hospitalization. There are no clinical studies that show a benefit of such a treatment. The aim of this study was to investigate whether heparin therapy in CAPD peritonitis is necessary.
Design And Patients:
194 samples of peritoneal dialysates were collected from 17 patients over a period of 24 months. Samples were subdivided into three groups: those without peritonitis (< 100 leukocytes/microL), those with mild peritonitis (100-499 leukocytes/microL), and those with severe peritonitis (> or = 500 leukocytes/microL).
Measurements:
The number of leukocytes per microL dialysate and total protein concentrations were determined. Furthermore, dialysate concentrations of thrombin-antithrombin III- (TAT-) complexes (indicator of thrombin formation), D-dimers (indicator of fibrinolysis), and plasminogen activator inhibitor 1 (PAI-1) were measured.
Results:
The dialysate protein concentration progressively increased from no peritonitis to mild and severe inflammation. In parallel, dialysate TAT-complex and D-dimer concentrations increased. Thrombin-antithrombin III-complex and D-dimer concentrations correlated strongly in 179 cases (r = 0.76; 62 samples showing peritonitis, 117 samples with no evidence of peritonitis). In the remaining 15 samples of 3 patients, high PAI-1 levels (> 40 ng/mL) and low D-dimer concentrations were found. Eleven of the 15 samples showed evidence of peritonitis. In these 11 samples with evidence of peritonitis, high levels of TAT-complexes were detected, while D-dimer concentrations were found to be very low, pointing to a blocked fibrinolysis. The PAI-1 levels were not related to leukocyte counts or protein concentrations in the dialysates.
Conclusions:
Based on our findings, the routine intraperitoneal administration of heparin in CAPD peritonitis is not necessary. In rare cases an imbalance between coagulation and fibrinolysis due to high PAI-1 levels exists (15 of 194 dialysate samples, 11 of the 15 samples showing peritonitis). These cases--which do require heparinization--can be identified by demonstrating low D-dimer levels in CAPD dialysate at times of peritonitis.