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document
Effect of unfractionated and low-molecular-weight heparin on OPG , sRANKL , and von Willebrand factor concentrations during hemodialysis . BACKGROUND Endothelial dysfunction marker , von Willebrand factor ( vWF ) , is physically connected with osteoprotegerin ( OPG ) in the Weibel-Palade bodies . We aimed to compare the effect of unfractionated ( UFH ) and low-molecular-weight ( LMWH enoxaparin ) heparin used as anticoagulants during hemodialysis ( HD ) on plasma levels and relationships of OPG , soluble receptor activator of nuclear factor κB Ligand ( sRANKL ) , and vWF . METHODS Totally 21 clinically stable chronic HD patients were randomly assigned to either enoxaparin ( n = 10 ) or UFH ( n = 11 ) anticoagulation and followed prospectively for 12 weeks before crossing over to the alternate therapy for further 12 weeks . The OPG , RANKL , and vWF levels were measured at T0 , T10 , and T180 of HD session after each period of evaluation . RESULTS The baseline sRANKL level was higher under UFH treatment . Its over-HD level does not behave significantly different under enoxaparin and UFH treatment . Plasma OPG levels expressly changed during both enoxaparin ( χ ( 2 ) analysis of variance [ ANOVA ] = 31.13 , P < .016 ) and UFH ( χ ( 2 ) ANOVA = 8.26 , P = .016 ) anticoagulation , and its increment at T10 and T180 was significantly different between both the heparins . The main negative predictor of OPG concentration was the total cholesterol level ( β = -.51 , P = .025 ) . von Willebrand factor concentration remained stable during UFH anticoagulation , whereas constant , no significant increments were noticed , under enoxaparin treatment . After 10 minutes of HD , especially under enoxaparin use , a positive correlation between OPG and vWF increase was noticed ( P = .03 , R = .45 ) . CONCLUSIONS Impact of heparin on endothelial cells and simultaneously on OPG/RANK/RANKL axis reinforces the presumption of the pathophysiological linkage between bone mineralization and endothelial dysfunction in end-stage renal disease .
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Intervention_Pharmacological
unfractionated
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Intervention_Pharmacological
low-molecular-weight heparin
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Intervention_Pharmacological
unfractionated ( UFH )
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Intervention_Pharmacological
low-molecular-weight ( LMWH enoxaparin ) heparin
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Participant_Condition
hemodialysis
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Participant_Condition
hemodialysis ( HD )
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Participant_Sample-size
Totally 21 clinically stable chronic HD patients
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Participant_Condition
dysfunction in end-stage renal disease