title: Intraperitoneal heparin ameliorates the systemic inflammatory response in PD patients.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) suffer from high mortality rates of cardiovascular diseases, conditions closely linked to the magnitude of their chronic low-grade inflammation. As heparins have been suggested to possess anti-inflammatory properties, we set out to investigate the impact of long-term treatment with intraperitoneal heparin on local and systemic inflammation in peritoneal dialysis (PD) patients.
  
  
  METHODS
  In a double-blinded cross-over study, 21 PD patients with ESRD were randomised to inject either 4,500 anti-Xa IU tinzaparin or placebo (isotonic saline) into their morning dialysis bags every day for two periods of 3 months separated by a 1-month wash-out period. Blood and dialysate samples were analysed for inflammatory markers at the start and end of each treatment period. In dialysate, the appearance rates of the inflammatory markers were calculated to adjust for ultrafiltration variations.
  
  
  RESULTS
  Eleven patients completed the trial. Treatment with intraperitoneal tinzaparin was accompanied with a median 25.8% reduction of the plasma C-reactive protein concentration (p = 0.032), a 7.3% reduction of the plasma fibrinogen concentration (p = 0.042) and a 54.5% reduction of the dialysate interleukin 6 appearance rate (p = 0.007) compared with placebo.
  
  
  CONCLUSIONS
  Long-term treatment with intraperitoneal tinzaparin of ESRD patients on PD reduces local and systemic concentrations of inflammatory markers.
authors.affiliation: Department of Clinical Biochemistry, Ribe County Hospital, Esbjerg, Denmark. sjoland@dadlnet.dk
authors.forename: Jonas Angel
authors.initials: JA
authors.lastname: Sjøland
authors.forename: Robert Smith
authors.initials: RS
authors.lastname: Pedersen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jespersen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Gram
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005337:Fibrin / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D007274:Injections, Intraperitoneal; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D000078222:Tinzaparin
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D005337:Fibrin; D002097:C-Reactive Protein