title: Effect of nadroparin on anti-Xa activity during nocturnal hemodialysis.
abstract: BACKGROUND
  Nadroparin is used during hemodialysis to prevent clotting of the extra corporeal system. During nocturnal hemodialysis patients receive an increased dosage of nadroparin compared to conventional hemodialysis. We tested whether the prescribed dosage regimen of nadroparin, according to Dutch guidelines, causes accumulation of nadroparin.
  
  
  METHODS
  Anti-Xa levels were used as an indicator of nadroparin accumulation. Anti-Xa was measured photometrically in 13 patients undergoing nocturnal hemodialysis for 4 nights a week. Nadroparin was administered according to Dutch dosage guidelines. We assessed anti-Xa levels at 4 time points during 1 dialysis week: before the start of the first dialysis session of the week (baseline), prior to (T1) and after the last dialysis session of the week (T2) and before the first dialysis of the following week (T3).
  
  
  RESULTS
  Patients received 71-95 IU/kg at the start of dialysis and another 50% of the initial dosage after 4 h with a total cumulative dosage of 128 ± 24 IU/kg. Anti-Xa levels increased from 0.017 at baseline to 0.019 at T1 (p = 0.03). Anti-Xa levels were 0.419 ± 0.252 IU/ml at T2 (p < 0.001 vs baseline and T1), whereas anti-Xa levels were not changed at T3 compared to baseline.
  
  
  CONCLUSIONS
  Dosing of nadroparin according to Dutch guidelines in patients on nocturnal hemodialysis does not lead to accumulation of nadroparin. We therefore consider the Dutch dosage guidelines for nadroparin an effective and safe strategy.
  
  
  CONCLUSIONS
  This article is the first to present data on anti-Xa activity during nocturnal hemodialysis which is a widely used and potentially dangerous therapy.
authors.affiliation: Department of Internal Medicine-Nephrology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.
authors.forename: Edward
authors.initials: E
authors.lastname: Buitenwerf
authors.affiliation: Department of Pharmacy, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.
authors.forename: Arne J
authors.initials: AJ
authors.lastname: Risselada
authors.affiliation: Department of Pharmacy, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.
authors.forename: Eric N
authors.initials: EN
authors.lastname: van Roon
authors.affiliation: Department of Epidemiology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.affiliation: Department of Internal Medicine-Nephrology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Hemmelder
keywords: Anti-Xa; Low molecular weight heparin; Nadroparin; Nocturnal hemodialysis