Effects of conventional vs. low-molecular-weight heparin on lipid profile in hemodialysis patients

Cardiovascular disease is one of the major causes of death in hemodialysis patients and seems to be related, at least in part, to lipid abnormalities. It has been suggested that in these patients low-molecular-weight heparin (LMWH) is superior to conventional heparin because it causes less side effects and has beneficial effects on lipid parameters. Our study was carried out to examine the long-term effects of the replacement of conventional heparin by LMWH on the lipoprotein profile in a large group of hemodialysis patients. A total of 76 patients aged 15-61 years receiving hemodialysis for 48 (range 10-169) months were studied. In all patients administration of LMWH was introduced in doses of 2,500-5,000 anti-factor Xa units for 12 months. Then, we randomly switched half of the patients back to conventional heparin for another 12 months, while the remaining patients continued to receive LMWH for 12 months. In the whole group of patients the use of LMWH instead of conventional heparin was followed by a significant decrease in serum total cholesterol, triglyceride and apoprotein B levels. The continued use of LMWH for another 12 months in half of the patients was followed by a further significant improvement in the lipid profile. In contrast, no significant changes in serum lipid parameters were observed in patients switched back to conventional heparin. In conclusion, the use of LMWH instead of conventional heparin for anticoagulation during hemodialysis is followed by an improvement in lipid profile, which is evident only after long-term treatment.