title: Effect of self-administered intraperitoneal bemiparin on peritoneal transport and ultrafiltration capacity in peritoneal dialysis patients with membrane dysfunction. A randomized, multi-centre open clinical trial.
abstract: BACKGROUND
  Progressive peritoneal membrane injury and dysfunction are feared repercussions of peritoneal dialysis (PD), and may compromise the long-term feasibility of this therapy. Different strategies have been attempted to prevent or reverse this complication with limited success.
  
  
  METHODS
  We performed a randomized, open multi-centre trial, aimed at scrutinizing the efficacy of self-administered intraperitoneal (i.p.) bemiparin (BM) to modulate peritoneal membrane dysfunction. The main outcome variables were peritoneal creatinine transport and the ultrafiltration (UF) capacity, estimated during consecutive peritoneal equilibration tests. The trial included a control group who did not undergo intervention. The treatment phase lasted 16 weeks with a post-study follow-up of 8 weeks.
  
  
  RESULTS
  Intraperitoneal BM did not significantly improve creatinine transport or the UF capacity, when the whole group was considered. However, we observed a time-limited improvement in the UF capacity for the subgroup of patients with overt UF failure, which was not observed in the control group. Intraperitoneal injection of BM did not carry an increased risk of peritoneal infection or major haemorrhagic complications.
  
  
  CONCLUSIONS
  Our data do not support the systematic use of BM for management of peritoneal membrane dysfunction in PD patients. Further studies on the usefulness of this approach in patients with overt UF failure are warranted. Intraperitoneal administration of BM is safe in PD patients, provided regulated procedures are respected.
authors: Department of Nephrology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. gpeso.hulp@salud.madrid.org
authors: Gloria
authors: G
authors: Del Peso
authors: M Auxiliadora
authors: MA
authors: Bajo
authors: Miguel Perez
authors: MP
authors: Fontán
authors: Javier
authors: J
authors: Martínez
authors: Belen
authors: B
authors: Marrón
authors: Rafael
authors: R
authors: Selgas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007274:Injections, Intraperitoneal; D007674:Kidney Diseases / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D010537:Peritoneum / Q000503:physiopathology*; D010538:Peritonitis / Q000453:epidemiology; D012307:Risk Factors; D012646:Self Administration; D014462:Ultrafiltration
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C411345:bemiparin