Prediction of time-averaged concentration of haemoglobin in haemodialysis patients.

BACKGROUND: Haemoglobin (Hb) concentration is not stable in most haemodialysis patients due to ultrafiltration-induced haemoconcentration. Pre-dialysis Hb concentrations might therefore significantly deviate from the time-averaged concentration (Hb-tac) which is more likely to represent the patients 'true' Hb. This study was performed to quantify these differences in our chronic haemodialysis population and to develop a formula for prediction of Hb-tac. METHODS: In 55 stable patients, serial blood samples were taken over a period of 2 weeks before and immediately after each haemodialysis as well as 30 min post-haemodialysis to account for post-dialytic fluid rebound. Hb-tac was calculated for every patient from the area under the time-dependent Hb curve. We compared the differences between Hb-tac and pre-dialysis Hb (Hb-pre) and various prediction formulae for Hb-tac generated by multiple linear regression analysis which included Hb-pre and post-dialysis Hb (Hb-post) and/or ultrafiltration rate (UFR). RESULTS: Mean Hb-pre after the long dialysis interval was significantly lower than after the short interval (11.47 vs 11.85 g/dl, P < 0.0001), both underestimating mean Hb-tac (11.97 g/dl). More interestingly, Hb-pre after the long interval deviated >0.5 g/dl from Hb-tac in 50% of measurements. After the short interval, 20% still lay outside this tolerance range. The best formula to predict Hb-tac was Hb-pre x 0.5 + Hb-post x 0.38 + 1.28 (6% outside +/- 0.5 g/dl). Hb-pre +(Hb-post - Hb-pre)/3 may be used for quick estimation of Hb-tac. CONCLUSIONS: Hb-tac can be predicted from pre- and post-dialysis blood samples after the short interval, using a simple new formula. Because Hb-tac more reliably reflects a 'true' Hb level of haemodialysis patients, it represents a potentially useful tool for future scientific and clinical work.     

Does increasing haemoglobin concentration and haematocrit have a pressor effect in dialysis patients?

The haemodynamic consequences of differing rates of rise of haemoglobin and haematocrit in haemodialysis and CAPD patients were examined. Pre-dialysis mean arterial pressure, weight and haematological indices were recorded in 100 established haemodialysis patients prior to a 2-unit blood transfusion and repeated, pre-dialysis, within 1 week. Haemoglobin rose from 6.7 +/- 0.2 to 9.3 +/- 0.1 g/dl, weight was unchanged, and there was a small fall in mean arterial pressure. Similar indices were recorded, including the mid-arm circumference (MAC) in 100 CAPD patients 1 month after starting CAPD and at the time of maximum haemoglobin within the first year. Haemoglobin rose from 8.5 +/- 0.1 to 10.7 +/- 0.1 g/dl, weight increased slightly, but there was no change in MAC: weight ratio and there was a small fall in mean arterial pressure. In neither group was there a change in antihypertensive medication. In conclusion, increasing the haemoglobin concentration and haematocrit of dialysis patients within the range described in this study did not promote elevated blood pressure.     

Changes in blood pressure and vasoactive hormones during volume expansion in stable patients on chronic haemodialysis

Summary: We studied changes in blood pressure (BP) and plasma hormones (atrial natriuretic peptide [ANP], brain natriuretic peptide [BNP], endothelin [ET], angiotensin [AII] and renin [PRA]) in four stable haemodialysis patients 48 h after a routine dialysis (basal stat), after volume expansion (4–7% above dry bodyweight) for 4 days then 48 h later following ultrafiltration. Blood pressure rose and plasma AII and PRA values fell with volume expansion and returned to baseline at the end of the study. Endothelin values were unchanged. Plasma ANP and BNP rose similarly in three patients and returned to near baseline levels after ultrafiltration. Sustained volume expansion over 4 days in dialysis patients is associated with an increase in BP, a marked elevation in plasma ANP and BNP but without change in ET.     

High haematocrit in haemodialysis patients can be controlled by theophylline administration

Three patients on chronic maintenance haemodialysis have progressivelyincreased their haematocrit to reach values between 40 and 45%,a situation associated with an increased risk of thrombosisof their arteriovenous fistulae. Two of them had been submittedto repeated phebotomies, which remained unsuccessful despitethe induction of a profound iron deficiency in one of them.Hence, a trial with oral theophylline was performed in the threepatients, resulting in a sustained decrease of the haematocrit(from 43.6 to 33%) and endogenous erythropoietin (from 46 to15 mU/ml) levels. In two patients, theophylline therapy wasstopped transiently due to gastrointestinal side-effects, whichresulted in a rapid return to previous haematocrit levels; rechallengewith a better tolerated preparation, however, was efficientagain. We conclude that oral theophylline appears to be an efficienttreatment to control too high haematocrit levels in dialysispatients.     

Carbamylated haemoglobin, urea kinetic modelling and adequacy of dialysis in haemodialysis patients

Urea kinetic modelling (UKM) has increasingly been used for assessing adequacy of dialysis and protein nutritional status of dialysis patients. Using a precise HPLC method we developed, we measured carbamylated haemoglobin (CarHb) values in 20 stable twice-weekly dialysed patients and attempted to correlate their CarHb values with their UKM-derived indices. Based on these indices, 11 patients were found to have been adequately dialysed with sufficient protein intake, three patients were adequately dialysed but malnourished and six patients were under-dialysed. Estimated dietary protein intake correlated poorly with calculated daily protein catabolic rate in our patients. CarHb values were found to correlate strongly with the time-averaged urea concentrations, suggesting that CarHb might be a time-integrated urea-derived index. Those adequately dialysed patients have a mean (SD) CarHb value of 142 (29) micrograms CV/gHb against the underdialysed patients, 197 (30) micrograms CV/gHb (t-test, P = 0.002). We suggest that a CarHb value less than 175 micrograms CV/gHb may represent satisfactory uraemic exposure, whereas CarHb value greater than 175 micrograms CV/gHb is undesirable.     

Mineral metabolism and haemoglobin concentration among haemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS).

BACKGROUND: Bone and mineral metabolism is abnormal in most chronic haemodialysis patients and is associated with a high mortality risk. Because of possible pathogenic links between anaemia and intact parathyroid hormone (iPTH), the present study evaluated associations of mineral metabolism indicators with haemoglobin (Hb). METHODS: Data were collected from 317 facilities (12 089 haemodialysis patients) in Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the United Kingdom and the United States by the Dialysis Outcomes and Practice Patterns Study (DOPPS). The major outcome studied was probability of haemodialysis patients having a target Hb, per guidelines, of >/=11 g/dl at baseline. Major predictor variables were patient characteristics and laboratory markers of mineral metabolism: albumin-corrected serum calcium (calcium(Alb)), serum phosphorus (PO(4)) and iPTH. Analyses were adjusted for demographics, 15 comorbidity classes, baseline laboratory values, body mass index, years on dialysis, erythropoietin dose, vitamin D and catheter use, cause of end-stage renal disease and country. RESULTS: The adjusted odds ratio (AOR) of having Hb >/=11 g/dl was significantly higher (P<0.0001) in patients with higher calcium(Alb) (AOR = 1.32 per 1 mg/dl), higher PO(4) (AOR = 1.08 per 1 mg/dl) and lower iPTH (AOR = 0.96 per 100 pg/ml). Furthermore, 4 month intrapatient changes in Hb concentration were significantly (P<0.0001) related to 4 month changes in calcium(Alb) (0.17 g/dl Hb rise per 1 mg/dl higher calcium(Alb)) and PO(4) (0.11 g/dl Hb rise per 1 mg/dl higher PO(4)). Mean weekly recombinant human erythropoietin (rHuEpo) doses were higher for patients with high PO(4) or iPTH levels, but lower for patients with calcium(Alb) >9.5 mg/dl, after patient mix and Hb concentration adjustments. CONCLUSIONS: The results of this study indicate that higher serum calcium(Alb) and PO(4) levels are each independently associated with better anaemia control. This relationship is independent of vitamin D use, PTH levels and prescribed rHuEpo dose. Despite this benefit of better anaemia control at higher serum calcium(Alb) and PO(4) concentrations, lower calcium and PO(4) levels, as recommended by the K/DOQI guidelines, should still serve as the long-term goal for HD patients in order to minimize tissue calcification and mortality risk.     

Determinants of haemoglobin carbamylation in haemodialysis and peritoneal dialysis patients.

BACKGROUND: Carbamylation is an irreversible process of non-enzymatic modification of proteins by the breakdown products of urea. For haemoglobin (Hb), the extent of carbamylation is a marker of urea exposure and has been proposed as an indicator of the control of uraemia by dialysis, analogous to the use of Hb glycosylation in diabetic patients. METHODS: We performed a cross-sectional study of haemodialysis (HD) and peritoneal dialysis (PD) patients in order to study potential determinants of carbamylated Hb (CarbHb) and to investigate the relationship between CarbHb and established measures of dialysis dose/adequacy by multivariate analysis. RESULTS: In 80 HD patients, CarbHb was independently predicted by post-dialysis urea (r=0.40, P:<0.01), serum albumin (r=0.24, P:<0.05) and serum bicarbonate (r=-0.40, P:<0. 05). No correlation was found between CarbHb and measures of dialysis dose/adequacy (Kt/V, urea reduction ratio, weekly dialysis duration, and normalized protein catabolic rate (nPCR)). In 42 PD patients, serum urea was the only significant independent predictor of CarbHb (r=-0.51, P:=0.001). No relationship was found between CarbHb and Kt/V, corrected creatinine clearance (CrCl) or nPCR in PD patients. CONCLUSIONS: Serum urea is the most consistent independent predictor of CarbHb in dialysis patients. This association in combination with the lack of a relationship with conventional measures of dialysis dose and a positive relationship with serum albumin suggest that a single measurement of CarbHb is unlikely to be a useful indicator of the adequacy of dialysis.     

Evaluation of coagulation and fibrinolysis in haemodialysis patients at different haematocrit levels: Comparison between patients with and without diabetes

SUMMARY: There is an insufficient number of reports concerning the optimal haematocrit level for haemodialysis patients with diabetes. Although many reports have indicated that recombinant human erythropoietin (rHuEPO) therapy does not influence the incidence of intravascular thrombosis, no study has focused its attention on the difference of the coagulation-fibrinolysis system between haemodialysis patients with and without diabetes. We studied eight patients with diabetes and seven patients without diabetes who had been undergoing regular haemodialysis. In all 15 patients, rHuEPO administration was started at a haematocrit level of 20% and toe haematocrit tevels were gradually increased from 20 to 30%. Coagulation and fibrinolysis functions, measured at haematocrit levels of 20,25 and 30%, respectively, were compared between the two groups. In the diabetic group, platelet count, fibrinogen, thrombin-antithrombin III complex, frtmn/fibrinogen degradation products = D dimer, platelet factor 4 and platelet adhesion were statistically higher ( P < 0.05), and plasminogen and α2-plasmin inhibitor was statistically lower ( P < 0.05) than those in the non-diabetic group, even at the 20% level. These abnormalities at the baseline were extremely enhanced in connection with haematocrit increased by rHuEPO. the diabetic group, in particular, showed greater increases of platelet factor 4, platelet adhesion and thrombomodulin and a decrease of α2-plasmin inhibitor from the 20% to the 30% level ( P < 0.05) than the non-diabetic group. These findings suggest that haemodialysis patients with diabetes generally have enhanced thrombotic parameters compared with haemodialysis patients without diabetes, and the increase of haematocrit makes the difference greater. Accordingly, the target level of haematocrit for patients with diabetes should be set separately from that of patients without diabetes.     

Control of hypertension and survival in haemodialysis patients

Hypertension is common in approximately 80% to 90% of patients at the start of dialysis therapy and is an established risk factor for cardiovascular disease. Therefore, it should be controlled, even in the chronic dialysis population. Observational studies indicate a U‐shaped phenomenon, as the mortality rate is high among those with hypertension as well as those with hypotension. Among chronic dialysis patients, randomized controlled trials on the effect of anti‐hypertensive treatment are not conclusive, at least not as demonstrated by studies with a large sample size. Similar to other potentially effective drug therapies such as erythropoietin stimulating agent, statins, and uraemic toxin adsorbents, the benefit of anti‐hypertensive treatment remains to be demonstrated in dialysis patients. The blood pressure target level, however, is difficult to determine as evidence for the level of appropriate target is lacking. Currently, it should be determined individually, as the priority is to perform haemodialysis as prescribed. The target levels of blood pressure for chronic haemodialysis patients are not stated except in the Guidelines in the Japanese Society for Dialysis Therapy. In this guideline, systolic blood pressure between 140 to 159 mmHg is preferable among elderly patients with comorbid conditions. Rapid ultrafiltration, such as >600 mL/h, is to be avoided. Intra‐dialysis hypotension, muscle cramps, and other complaints during HD are preventable. Moreover, the nutritional status should be maintained within the normal range with adequate intake of protein and calories, but with salt restriction. Further studies are necessary for better management of hypertension in the dialysis population.     

Intra- and post-dialytic changes of haemoglobin concentrations in non-anaemic haemodialysis patients.

BACKGROUND: Non-anaemic haemodialysis (HD) patients are potentially more prone to the adverse effects of ultrafiltration-induced haemoconcentration. No study, however, has assessed the effects of dialytic session on haemoglobin (Hb) levels in these patients. METHODS: The levels of Hb and total protein before, at the end (T0) and up to 120 min (T120) after the third HD session of the week were compared in non-anaemic (Hb >13 g/dl, n = 14, NOR) and anaemic (Hb = 11-12 g/dl, n = 18, LOW) HD patients. RESULTS: The intradialytic weight loss was similar in the two groups (4.0 +/- 0.9 and 4.1 +/- 0.9% body weight). During the treatment, Hb levels increased to the same extent in both groups (from 14.4 +/- 1.2 to 16.3 +/- 1.9 g/dl in NOR, and from 11.4 +/- 0.8 to 12.7 +/- 0.9 g/dl in LOW) in the presence, presumably, of a smaller plasma volume in NOR, whereas the increment of total protein was greater in NOR (from 7.1 +/- 0.2 to 9.6 +/- 0.5 g/dl) than in LOW (from 7.3 +/- 0.6 to 8.7 +/- 0.8 g/dl) (P < 0.0001). At T120, the Hb decline in NOR was almost double that measured in LOW (-9.2 +/- 3.0 vs -4.7 +/- 2.4%, P < 0.001). Consequently, Hb concentration did not differ from the pre-dialytic value in NOR (P = 0.10), but persisted higher in LOW (P < 0.005). The extent of the post-dialytic decrement of Hb was inversely related to the total protein values at T0 (r = -0.547, P = 0.0012). CONCLUSIONS: This study indicates that in NOR: (i) the extent of intradialytic increment of Hb is limited by a greater intradialytic plasma refilling; (ii) the greater plasma refilling persists after the end of dialysis, with the restoration of pre-dialytic Hb levels within the initial 2 h; and (iii) the force driving this phenomenon resides mainly in the larger changes of total protein concentration.     

Inverse relationships between haemoglobin and ristocetin-induced platelet aggregation in haemodialysis patients under erythropoietin therapy

BACKGROUND.: Amelioration of the anaemia of chronic renal failure and subsequentimproved haemorheology result in correction of bleeding diathesisas evidenced by shortening of the skin bleeding time (BT). However,the relationship between the haematocrit and platelet-vesselwall interactions in haemodialysis (HD) patients under recombinanthuman erythropoietin (rHuEpo) therapy, assessed by plateletaggregation in response to ristocetin is more complex and somewhatinconsistent. METHODS.: We investigated the relationship between haemoglobin (Hb) levelsand whole blood ristocetininduced platelet aggregation (electricimpedance method) in 28 HD patients treated with rHuEpo, andwith normal BT. The measurements were repeated in 16 subjectsafter having reduced platelet aggregability with orally administeredketanserin. RESULTS.: Ristocetin-induced platelet aggregation in the whole group wascomparable to those found in 21 age-matched healthy subjects(normals) and in 25 HD patients not treated with rHuEpo (uraemics).Interestingly, a significant inverse correlation between thisaggregation and Hb concentration was found (r = –0.392,P<0.05). In the group of 16 patients, the preketanserin aggregationwas more intensive than in the normals and uraemics (P<0.05).Ketanserin produced a fall in ristocetin-induced platelet aggregation(P<0.02), prolongation of the BT (P<0.02) and, unexpectedly,a decrease in serum Epo concentration (P<0.0002) and theHb level (P<0.001). Again, an inverse correlation betweendepressed ristocetin-induced platelet aggregation and loweredHb concentration was found (r= –0.590, P<0.02). Moreover,a strong positive correlation between the extent of preketanserinplatelet aggregation and the decrease in the intensity of thisprocess that followed the trial was observed (r=0.919, P<0.000005).There were no changes in other haematological parameters orarterial blood pressure. CONCLUSIONS.: Considering the role of von Willebrand factor and fibrinogenin mediating ristocetin-induced platelet aggregation, and enhancedsynthesis and/or release of these macromolecules in responseto uraemia or inflammation, we suggest that exaggerated whole-bloodplatelet aggregability to ristocetin points to blunted erythropoiesisin HD patients on rHuEpo therapy.     

Fluctuations in haemoglobin levels in haemodialysis, pre-dialysis and peritoneal dialysis patients receiving epoetin alpha or darbepoetin alpha

Aim: To characterize the haemoglobin variability of haemodialysis, peritoneal dialysis and pre‐dialysis patients treated with either epoetin alpha or darbepoetin alpha in a clinical setting where treatment was administered according to current standard Australian practice. Methods: Data on haemodialysis, pre‐dialysis and peritoneal dialysis patients were extracted from the Renal Anaemia Management database (RAM) from 1 January 2001 to 31 December 2004. The variance in haemoglobin was calculated from patient records with more than five haemoglobin observations over a period of at least 4 weeks following 9 weeks of therapy. A mixed‐model was fitted to the within‐patient variances and weighting was based on the number of observations minus 1 for each record. Results: The mean within‐patient variance in haemoglobin levels for i.v. administered erythropoietin‐stimulating agents (IV) haemodialysis, s.c. administered erythropoietin‐stimulating agents (SC) haemodialysis, predialysis_SC and peritoneal dialysis_SC patients receiving epoetin alpha were 9% (95% CI: 13% to 5%, P < 0.0001), 17% (95% CI: 32% to 0.2%, P = 0.047), 19% (95% CI: 27% to 11%, P < 0.0001) and 26% (95% CI: 33% to 18%, P < 0.0001) lower than that for patients receiving darbepoetin alpha. The mean haemoglobin levels for haemodialysis_IV, haemodialysis_sc predialysis_SC and peritoneal dialysis_SC patients receiving darbepoetin alpha were 11.6 g/dL, 11.2 g/dL, 11.5 g/dL and 11.5 g/dL compared with 11.5 g/dL, 11.6 g/dL, 11.7 g/dL and 11.5 g/dL for patients receiving epoetin alpha. Conclusion: There was 9–26% greater within‐patient fluctuation in haemoglobin levels in patients receiving darbepoetin alpha compared with epoetin alpha. The causes of haemoglobin fluctuations and the implications for patient outcomes and resource use require further study.     

Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients.

BACKGROUND: Hypertension and left ventricular hypertrophy (LVH) are present in the majority of patients undergoing haemodialysis (HD). These two pathologies persist after dialysis onset, and pharmacological therapy is often required for adequate control of blood pressure (BP). Although fluid overload is a determinant of hypertension, clinical assessment of this parameter remains difficult and unsatisfactory. Bioimpedance analysis (BIA) spectroscopy and the relative determination of extracellular water (ECW%) may provide a simple and inexpensive tool for investigating fluid overload. We studied 110 patients on thrice-weekly HD to determine whether ECW body content correlates with hypertension and LVH in this patient population. METHODS: Hypertension was determined according to the WHO criteria (office BP >/= 140/90 and/or the use of antihypertensive therapy). Twenty-four hour BP monitoring and echocardiography were performed on midweek inter-HD days. Blood chemistries, dialysis dose (spKt/V) and bioimpedance were analysed on midweek HD days. RESULTS: Hypertension was present in 74.5% of patients. There were no differences for age, spKt/V, haemoglobin, serum creatinine and residual renal function between normotensive and hypertensive patients. Twenty-four hour systolic BP (SBP), 24 h diastolic BP and 24 h pulse pressure were higher in hypertensive patients, in spite of antihypertensive therapy. LVH was present in 61.8% of patients. BIA revealed that ECW% was increased in LVH+ patients (LVH+ = 47.5 +/- 7.9%, LVH- = 42.4 +/- 6.2%, P = 0.01) and in hypertensive patients compared with normotensives (46.5 +/- 7.7% vs 43 +/- 7.2%, P = 0.02). Dry body weights and inter-HD body weight increases did not differ between hypertensive and normotensive patients nor between patients with or without LVH. ECW was correlated with SBP (r = 0.35, P < 0.01) and with left ventricular mass index (LVMi(g/sqm)) (r = 0.49, P < 0.001). A stepwise multiple linear regression model revealed that LVMi(g/sqm) was significantly correlated with ECW%, SBP and male gender (r = 0.65, P < 0.001). CONCLUSIONS: LVH and hypertension are present in a majority of HD patients and they are closely correlated with one another. We found associations between fluid load, measured by BIA and expressed as ECW, and BP and LVM.     

Ultradian variation in serum phosphate concentration in patients on haemodialysis

To study how much the serum phosphate concentration could varyon the day before scheduled dialysis we obtained 24–37timed measurements during 24 h in nine patients on maintenancehaemodialysis. During the observation there was an increasein serum phosphate concentration of 0.239 ± 0.022, P/<0.01).Surprisingly six of the nine patients exhibited nine statisticallyand clinically significant nadirs with decrements of 0.21±0.04mmol/1 against an intra-assay standard deviation of about 0.05mmol/1. Five of the nadirs occurred at 11.40–14.50, mean12.59, and three at 19.00–21.30, mean 20.00. We foundno coinciding changes in the serum calcium concentration. Thesefindings indicate that serum phosphate concentrations do notalways reflect phosphorus balance or intake.     

Serum chromogranin A concentration and intradialytic hypotension in chronic haemodialysis patients

Aim The aim of this study was to investigate the influence of haemodialysis on plasma chromogranin A (CgA) concentration and to assess the relationship between CgA, blood pressure, occurrence of intradialytic hypotension episodes and residual renal function, respectively. Methods The study included 38 chronic haemodialysis patients (24 M, 14 F; mean age 56.2 ± 13.6 years). Plasma CgA and blood pressure were measured before and after a mid-week dialysis. Control group included 10 age- and sex-matched healthy subjects. Results Plasma CgA levels were on average 50-fold higher in HD patients than in the controls (699 ± 138 vs. 14 ± 6 U/L). In HD patients plasma CgA corrected for ultrafiltration rates significantly increased (to 836 ± 214 U/L, P < 0.001) at the end of dialysis procedure. In patients with (n = 8) and without frequent symptomatic intradialytic hypotension episodes predialysis values of CgA were similar (701 ± 169 vs. 698 ± 132 U/L) but post-dialysis were significantly lower in the former group (746 ± 312 vs. 860 ± 177 U/L; P = 0.03) despite a similar rate of ultrafiltration (2675 ± 1009 and 2583 ± 1311 ml, respectively). Accordingly, in patients with intradialytic hypotension an increase of plasma CgA during dialysis was also much lower than in patients without hypotension (45 ± 81 vs. 163 ± 144 U/L; P = 0.001). Conclusions CgA undergoes marked accumulation in renal failure. The increase of plasma CgA during dialysis is impaired in subjects with intradialytic hypotension episodes, which confirms the role of autonomic dysfunction in the pathogenesis of this complication.     

纤维支气管镜经口气管插管对老年高血压患者血管活性物质的影响

目的 探讨全身麻醉诱导后光导纤维支气管镜(FOB)经口气管插管对老年高血压患者血浆血管活性物质的影响.方法 32例ASA Ⅱ或Ⅲ级,高血压Ⅱ级,年龄≥60岁行择期胆囊切除术患者,随机均分为FOB组与直接喉镜组(LS组).静脉诱导后分别行气管插管,并于麻醉诱导前(T<,1>)、气管插管成功即刻(T<,2>)及成功后5 min(T<,3>)监测血浆内皮素(ET)、血管紧张素Ⅱ(AngⅡ)及降钙素基因相关肽(CGRP)变化.结果 T<,2>、T<,3>时FOB组血浆ET、Ang Ⅱ浓度明显低于LS组(P<0.05),而各时点两组CGRP组间差异均无统计学意义.结论 FOB经口气管插管对老年高血压患者血浆血管活性物质的浓度的影响较直接喉镜小.     

Plasma antithrombin III concentration in patients on regular haemodialysis treatment

Plasma concentration of antithrombin III (AT III) was measured by both immunological and functional assays before, during and after treatment with haemodialysis in 42 patients with chronic renal failure on regular long-term haemodialysis. Intravenous heparin administration during the haemodialysis session was found not to induce a consumption of the circulating AT III.