title: Current status of anticoagulant treatments and improvements for hemodialysis patients in northern Chinese cities: a five-year comparative study.
abstract: BACKGROUND
  Anticoagulation treatments are an important aspect of hemodialysis; however, few reports have addressed these treatments. This investigation intends to increase the understanding of the current status and improvements of hemodialysis-related anticoagulation treatments in China.
  
  
  METHODS
  In this study, an epidemiological investigation was conducted that examined 842 patients in 2007 and 1 175 patients in 2012 who underwent hemodialysis anticoagulation treatments in seven blood purification centers in northern Chinese cities.
  
  
  RESULTS
  Heparin was the most commonly used anticoagulant, although the percentage of use of low-molecular-weight heparin (LMWH) increased from 26.5% in 2007 to 42.1% in 2012. In 2007, there were no significant differences in anticoagulant selection among either patients with various primary diseases or patients with hemorrhage, thrombosis, thrombocytopenia, or a low hemoglobin level. However, compared with patients with other diseases, significantly lower doses of LMWH were administered to patients with hypertension (55.5 U/kg vs. 67.3 U/kg, P < 0.05) or diabetes (58.5 U/kg vs. 67.3 U/kg, P < 0.05), and patients with hemorrhage received lower doses of heparin than the other patients (61.6 U/kg vs. 71.8 U/kg, P < 0.01). In 2012, patients with diabetic nephropathy (51.5% vs. 36.5%, P < 0.01), hemorrhage (43.4% vs. 31.7%, P < 0.01), or a hemoglobin level below 90 g/L (57.2% vs. 37.1%, P < 0.01) experienced significantly higher doses of LMWH administration; patients with hemorrhage received significantly reduced LMWH dosages (50.4 U/kg vs. 57.8 U/kg, P < 0.05), and patients with thrombosis received significantly higher doses of heparin (73.8 U/kg vs. 62.1 U/kg, P < 0.01) or LMWH (57.8 U/kg vs. 52.6 U/kg, P < 0.05). Antiplatelet drugs were administered to 20.4% of the examined patients in 2007 and 20.7% in 2012. In 2012, patients with hypertension (25.9% vs. 18.5%, P < 0.01) and thrombosis (36.6% vs. 16.1%, P < 0.01) had a higher rate of using antiplatelet drugs than patients with other primary diseases and complications. Patients receiving antiplatelet drugs also received higher doses of heparin than patients without using antiplatelet drugs (74.4 U/kg vs. 65.9 U/kg, P < 0.01). However, the use of the drugs was not correlated with thrombocytopenia. The rate at which coagulation indices were determined increased from 45.7% in 2007 to 64% in 2012.
  
  
  CONCLUSIONS
  These findings suggested that hemodialysisrelated anticoagulation treatments in China have gradually become more standardized and individualized.
authors.affiliation: Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05) Beijing 100853, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05) Beijing 100853, China. Email: xfssun@126.com.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Nephrology, First Affiliated Hospital, Dalian Medical College, Dalian, Liaoning 116023, China.
authors.forename: Hongli
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Nephrology, General Hospital of the General Headquarters, Beijing 100091, China.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, First Affiliated Hospital, Harbin Medical College, Harbin, Heilongjiang 150081, China.
authors.forename: Lirong
authors.initials: L
authors.lastname: Hao
authors.affiliation: Department of Nephrology, First Affiliated Hospital, Chinese Medical University, Shenyang, Liaoning 110001, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yao
authors.affiliation: Department of Nephrology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China.
authors.forename: Jijun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05) Beijing 100853, China.
authors.forename: Delong
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05) Beijing 100853, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05) Beijing 100853, China.
authors.forename: Hanyu
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease (2011DAV00088), National Clinical Research Center of Kidney Diseases (2013BAI09B05) Beijing 100853, China.
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002681:China; D002947:Cities; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight