IS HEPARIN-THERAPY NECESSARY IN CAPD PERITONITIS

Objective: Heparin therapy in continuous ambulatory peritoneal dialysi s (CAPD) peritonitis seems well established; it is costly due to the n ecessity 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 thre e groups: those without peritonitis (<100 leukocytes/mu L), those with mild peritonitis (100 - 499 leukocytes/mu L), and those with severe p eritonitis( greater than or equal to 500 leukocytes/mu L). Measurement s: The number of leukocytes per mu L dialysate and total protein conce ntrations were determined. Furthermore, dialysate concentrations of th rombin-antithrombin III- (TAT-) complexes (indicator of thrombin forma tion), D-dimers (indicator of fibrinolysis), and plasminogen activator inhibitor 1 (PAI-1) were measured. Results: The dialysate protein con centration progressively increased from no peritonitis to mild and sev ere inflammation. In parallel, dialysate TAT-complex and D-dimer conce ntrations increased. Thrombin-antithrombin Ill-complex and D-dimer con centrations correlated strongly in 179 cases (r = 0.76; 62 samples sho wing 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 periton itis, high levels of TAT-complexes were detected, while D-dimer concen trations were found to be very low, pointing to a blocked fibrinolysis . The PAI-1 levels were not related to leukocyte counts or protein con centrations 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 samp les, 11 of the 15 samples showing peritonitis). These cases - which do require heparinization - can be identified by demonstrating low D-dim er levels in CAPD dialysate at times of peritonitis.