Over-dialysis plasma RANTES increase depends on heparin dose and cardiovascular disease status

Abstract

Purpose: The lifespan of maintenance hemodialysis patients is reduced mainly because of cardiovascular complications due to accelerated atherosclerosis and impaired angiogenesis. We aimed to compare the effect of unfractionated heparin (UFH) and enoxaparin used as anticoagulants during hemodialysis (HD) on circulating levels of heparin-binding, anti-angiogenic Endostatin, pro-inflammatory RANTES (Regulated upon Activation, Normal T cell Expressed and Secreted), and MCP-1 (Monocyte Chemoattractant Protein-1).

Methods: We enrolled 22 chronic HD patients, who were randomly assigned to either enoxaparin (n=11) or UFH (n=11) anticoagulation, and followed prospectively for 12 weeks before crossing over to the alternate therapy for further 12 weeks. The factors were measured (ELISA) at the start, 10 and 180 min of HD, and compared to 20 healthy volunteers.

Results: The baseline Endostatin, RANTES, and MCP-1 levels in patients were higher than in controls and comparable during enoxaparin and UFH treatment. RANTES significantly increased during both enoxaparin and UFH anticoagulated HD, while over-HD Endostatin and MCP-1 levels remained stable regardless of the heparin sort. About 25% RANTES increase after 10 min of HD positively correlated with the dose of both heparins and HD duration. The switch from enoxaparin to UFH treatment had no impact on the levels of parameters studied. Patients with ischemic heart disease had less RANTES increase after 180 min of HD especially during enoxaparin treatment.

Conclusion: RANTES is dose-depended and transitory increased in response to both UFH and enoxaparin administration during HD. Cardiovascular disease status occurred to be the most important predictor of its over-HD level.