LOW-MOLECULAR-WEIGHT HEPARIN IN DIABETIC AND NONDIABETIC HYPERCHOLESTEROLEMIC PATIENTS RECEIVING LONG-TERM HEMODIALYSIS

Dyslipidemia is a major factor associated with cardiovascular disease, which is the leading cause of death in hemodialysis patients. Low mol ecular weight heparin (LMWH) is superior to conventional unfractionate d heparin in treating hyperlipidemia in nondiabetic long-term hemodial ysis patients and has fewer side-effects. Only a few reports have addr essed the influence of LMWH on serum lipids in diabetic patients, alth ough dyslipidemia is common among this population. We investigated the effect of LMWH on serum lipids in 12 nondiabetic and eight diabetic h ypercholesterolemic patients receiving long-term hemodialysis. Patient s had been receiving hemodialysis with unfractionated heparin for a mi nimum of 6 months before beginning the study. Continuous LMWH infusion during hemodialysis was administered to all patients for 2 months, fo llowed by unfractionated heparin administration for 2 months. During L MWH treatment, plasma anti-factor Xa activity increased from 0.06 +/- 0.04 IU/mL before dialysis to 0.49 +/- 0.25 IU/mL after 3 hours. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and apolipoprotein B (Apo B) in both nondiabetic and diabetic patient groups and lipoprotein(a) (Lp(a)) in patients with higher initial valu es (greater than or equal to 15 mg/mL) decreased significantly after L MWH treatment (TC from 6.38 +/- 1.14 to 5.07 +/- 1.09 mmol/L, LDL-C fr om 3.08 +/- 0.93 to 2.15 +/- 0.88 mmol/L, Apo B from 100 +/- 18 to 78 +/- 18 mg/dL, all p < 0.01; Lp(a) from 41.8 +/- 34.5 to 28.5 +/- 22.8, p < 0.05). They rebounded to pre-LMWH levels after the 2 months on un fractionated heparin (TC 5.72 +/- 1.11 mmol/L, LDL-C 2.97 +/- 1.01 mmo l/L, Apo B 98 +/- 20 mg/dL, Lp(a) 38.1 +/- 29.0 mg/dL). We conclude th at continuous infusion of LMWH during dialysis reduces serum total cho lesterol, low-density lipoprotein-cholesterol, and apolipoprotein B co ncentrations in both diabetic and nondiabetic hypercholesterolemic hem odialysis patients, and does not increase the risk of bleeding compare d with unfractionated heparin.