title: Effect of low molecular weight heparin on bone metabolism and hyperlipidemia in patients on maintenance hemodialysis.
abstract: The effect of low molecular weight heparin (LMWH) on serum lipid profile in hemodialysis remains controversial and its effect on bone metabolism has not been studied. A crossover study was conducted in 40 patients on stable hemodialysis using unfractionated heparin (UFH) for more than 24 months. These patients were then treated with a LMWH (nadroparin-Ca) for 8 months during hemodialysis and subsequently switched back to UFH for 12 months. Serum lipid profile, biochemical markers for bone metabolism, and bone densitometry (BMD) were monitored at four-month intervals while all medications remained unchanged. Cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), lipoprotein(a) (Lp(a)), apolipoprotein B (Apo B) were raised in 35%, 29%, 12%, 24% and 24% of patients respectively. High-density lipoprotein-cholesterol (HDL-C) and apolipoprotein A1 (Apo A-1) were reduced in 47% and 9% of patients. Bone-specific alkaline phosphatase (BALP) and intact osteocalcin (OSC), both reflecting osteoblastic activity, were raised in 65% and 94% of patients. Tartrate-resistant acid phosphatase (TRACP) reflecting osteoclastic activity and parathyroid hormone (PTH) were elevated in 35% and 88% of patients. Following LMWH treatment, TC, Tg, Lp(a) and Apo B were reduced by 7%, 30%, 21% and 10% respectively (p<0.05 or <0.01) while Apo A-1 were raised by 7% (p<0.01). Simultaneously, TRACP was reduced by 13% (p<0.05). These biochemical changes were detected soon after 4 months of LMWH administration. Although BMD values in our patients were lower than those of age-matched normal subjects, significant changes were not observed with LMWH treatment. After switching back to UFH for hemodialysis, these biochemical indices reverted to previous values during UFH treatment with a significant higher level in TC and Apo B while serum Apo A-1 remained elevated. Our study suggests LMWH may partially alleviate hyperlipidemia and, perhaps, osteoporosis associated with UFH administration in patients on maintenance hemodialysis.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, China. knlai@hkucc.hku.hk
authors.forename: K N
authors.initials: KN
authors.lastname: Lai
authors.forename: K
authors.initials: K
authors.lastname: Ho
authors.forename: R C
authors.initials: RC
authors.lastname: Cheung
authors.forename: L C
authors.initials: LC
authors.lastname: Lit
authors.forename: S K
authors.initials: SK
authors.lastname: Lee
authors.forename: K S
authors.initials: KS
authors.lastname: Fung
authors.forename: M K
authors.initials: MK
authors.lastname: Tong
authors.forename: C W
authors.initials: CW
authors.lastname: Lam
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism*; D018592:Cross-Over Studies; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016037:Single-Blind Method
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D006495:Heparin, Low-Molecular-Weight