Buitenwerf, E. (Edward) (2014) Effect van nadroparine op anti-Xa activiteit tijdens nachtelijke hemodialyse. thesis, Medicine.
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Abstract
Background: Nadroparin is used during hemodialysis to prevent clotting in the extra corporeal system. During nocturnal hemodialysis patients receive an increased dosage of nadroparin compared to conventional hemodialysis due to the intensified frequence and duration of dialysis. It is unknown whether the prescribed dosage regime of nadroparin during nocturnal hemodialysis leads to accumulation. Aim of the study: To asses if accumulation of nadroparin occurs during nocturnal hemodialysis. Materials and Methods: We tested Anti-Xa levels in 13 clinically stable patients undergoing nocturnal hemodialysis 4 nights a week (session duration 8 hours). Dosages nadroparin were administered according to the guidelines of the Dutch Federation of Nephrology. We assessed anti-Xa levels at 4 time points during one 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). Secondary outcomes were the clotting and bleeding events during this week. Anti-Xa levels were measured photometrically using a chromogenic technique. The paired two-sample t-test was used for the statistical analysis. Results: Patients received 55-81 IU/kg at the start of dialysis and 50% of the initial dosage after 4 hours with a total dosage of 128±24 IU/kg. The mean dosage nadroparin for patients also using acenocoumarol (n=5) was 111±15 IU/kg, whereas it was 139±22 IU/kg in the other 8 patients (p<0.05). Anti-Xa levels were 0,017 ± 0.018 IU/ml at baseline. At T1 anti-Xa levels were significantly elevated (p=0,026), in comparison to baseline, by 0,02 IU/ml. At T2 anti-Xa levels were 0,419 ± 0,252 IU/ml (p<0.05 vs B and T1). At T3 anti-Xa levels are equal to B (p=0,77). No major clotting or bleeding events were observed. Standard monthly laboratorium testing remained stable during the testing period. Conclusion: The used dosage regime of nadroparin during nocturnal hemodialysis according to the Dutch guidelines does not induce accumulation of nadroparin. In addition, it seems a save and effective dosage in our population.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hemmelder, dr. M.H. and Medisch Centrum Leeuwarden and afdeling nefrologie/dialyse centrum |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1340 |
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