Abstract
Background
The aim of this study was to investigate whether dalteparin is a safe and effective anticoagulant for paediatric home haemodialysis (HD) and to assess the determinants of dosing.
Methods
Data were collected for all children (< 18 years) undergoing home HD from 2011 to 2017 at one large paediatric nephrology centre in the UK. All children had anticoagulation with dalteparin sodium according to a standardised protocol. Dalteparin safety was assessed by monitoring for accumulation, adequate clearance of dalteparin and adverse events. Dalteparin efficacy was assessed through monitoring for clot formation in dialysis circuits. Potential determinants of dalteparin dosing were assessed.
Results
Eighteen children were included, their median age at start was 12 years, and 50% were male. Eighty-three percent of children had four home HD sessions each week, with a median total dialysis hours of 20 h/week. Thirty-three percent of children had nocturnal home HD. Median dalteparin dose at 12-month follow-up was 40 IU/kg (range 8–142 IU/kg). Factors associated with higher dalteparin dosing requirements included a younger age of the child (p < 0.01), a lower blood flow rate (p < 0.01) and the use of a central venous line for dialysis access (p = 0.038). No children had evidence of bioaccumulation of dalteparin or inadequate clearance. No significant bleeding or adverse events were reported.
Conclusions
Dalteparin is a safe and effective anticoagulant when used for paediatric home HD. In this study, there was no evidence of bioaccumulation or significant adverse events. Further research is required to directly compare dalteparin with unfractionated heparin (UFH) and evaluate anticoagulant choice for paediatric home HD.
Similar content being viewed by others
References
Kaur A, Davenport A (2014) Hemodialysis for infants, children and adolescents. Hemodial Int 18:573–582
Hothi DK, Stronach L, Sinnott K (2016) Home hemodialysis in children. Hemodial Int 20:349–357
Davenport A (2009) Review article: low-molecular-weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments. Nephrology 14:455–461
Davenport A (2012) Alternatives to standard unfractionated heparin for pediatric hemodialysis treatments. Pediatr Nephrol 27:1869–1879
Sagedal S, Hartmann A, Sundstrøm K, Bjørnsen S, Brosstad F (1999) A single dose of dalteparin effectively prevents clotting during haemodialysis. Nephrol Dial Transplant 14:1943–1947
Hofbauer R, Moser D, Frass M, Oberbauer R, Kaye AD, Wagner O, Kapiotis S, Druml W (1999) Effect of anticoagulation on blood membrane interactions during hemodialysis. Kidney Int 56:1578–1583
Goldstein SL, Silverstein DM, Leung JC, Feig DI, Soletsky B, Knight C, Warady BA (2008) Frequent hemodialysis with NxStage system in pediatric patients receiving maintenance hemodialysis. Pediatr Nephrol 23:129–135
Geary DF, Piva E, Tyrrell J, Gajaria MJ, Picone G, Keating LE, Harvey EA (2005) Home nocturnal hemodialysis in children. J Pediatr 147:383–387
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics
This study was approved through institutional audit and did not require separate ethical approval as it was retrospective. All data extraction and analysis were performed by members of the clinical care team.
Disclosures
None.
Rights and permissions
About this article
Cite this article
Lutkin, M., Stronach, L., Yadav, P. et al. Dalteparin anticoagulation in paediatric home haemodialysis. Pediatr Nephrol 33, 2337–2341 (2018). https://doi.org/10.1007/s00467-018-4032-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-018-4032-1