Intraperitoneal heparin reduces peritoneal permeability and increases ultrafiltration in peritoneal dialysis patients

Background. Patients on long-term treatment with peritoneal dialysis (PD) suffer from increasing peritoneal permeability and loss of ultrafiltration as a result of persistent inflammation, which may be triggered by bioincompatible dialysis fluids. Heparins have anti-inflammatory and anticoagulant properties. We have examined the effect of intraperitoneal (IP) low-molecular weight heparin (tinzaparin) on peritoneal permeability and ultrafiltration in PD patients. Methods. By means of a double-blinded cross-over design, 21 PD patients were randomized to receive either placebo or tinzaparin intraperitoneally once a day for two treatment periods of 3 months, separated by a wash-out period. The effect of heparin on peritoneal permeability and ultrafiltration was assessed using the 4 It standard peritoneal equilibration test. Results. IP tinzaparin reduced significantly the dialysate-to-plasma ratios (D/P) of creatinine (P < 0.01), urea (P < 0.01) and albumin (P < 0.05). In addition, the ratio of glucose concentration in dialysate at 4 h dwell to that of 0 h dwell (D-4/D-0) was increased (P < 0.05) along with an increase in ultrafiltration volume (P < 0.05). Conclusions. IP tinzaparin reduces peritoneal permeability to small solutes and increases ultrafiltration in PD patients.