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Is heparin therapy necessary in CAPD peritonitis?
C Nadig1, U Binswanger, A von Felten
1Department of Nephrology, University Hospital, Zurich, Switzerland.
Summary
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.