Lipid and Bone Effects of Heparin Use During Hemodialysis

Bernd Stegmayr; Li Zuo; Ward Zadora

doi:10.1016/j.semnephrol.2023.151480

Lipid and Bone Effects of Heparin Use During Hemodialysis

Semin Nephrol. 2024 Jan 8:151480. doi: 10.1016/j.semnephrol.2023.151480. Online ahead of print.

Authors

Bernd Stegmayr¹, Li Zuo², Ward Zadora³

Affiliations

¹ Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden. Electronic address: bernd.stegmayr@umu.se.
² Department of Nephrology, Peking University People's Hospital, Beijing, China.
³ Nephrology and Renal Transplantation Research Group, Catholic University of Leuven, Leuven, Belgium.

PMID: 38195305
DOI: 10.1016/j.semnephrol.2023.151480

Abstract

Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly prescribed anticoagulants for chronic hemodialysis (HD). The dialysis population comprises a unique group that receives heparin three times per week for a long period, with potential long-term cumulative metabolic effects such as osteoporosis and worsening lipid profile. HD patients have approximately half the number of lipases as healthy individuals, and their lipid metabolism is limited because of this decrease as well as partially inhibited function. Administration of UFH or LMWHs for anticoagulation can lead to metabolic starvation despite high triglyceride levels at the end of HD. In vitro studies indicate that UFH and LMWHs inhibit osteoblasts and promote osteoclasts. In patients on HD, long-term use of UFH or LMWHs did not worsen chronic kidney disease-mineral bone disease. Further investigation is needed to elucidate the underlining mechanisms of UFH and LMWHs and their possible influences on maintenance HD patients.

Keywords: Hemodialysis; bone; dialysis; heparin; lipid; metabolism.

Publication types

Review