Urokinase can reduce heparin dose in patients with hypercoagulable states during hemodialysis

Figures & data

Table 1. Patient characteristics.

	Sex	Age (y)	Primary cause	Dry weight	Pre-dialysis BUN (mmol/L)	Pre-dialysis Cr (μmol/L)	Duration of dialysis (y)
1	m	82	Gouty kidney	49.7	22	627	1.7
2	m	48	Glomerulonephritis	73	27.4	1024	10
3	m	44	Glomerulonephritis	44	25.3	767	9.5
4	m	70	Glomerulonephritis	63.5	30.5	771	7.5
5	m	68	Glomerulonephritis	64	25.5	883	11.7
6	m	38	Glomerulonephritis	63.8	27.5	803	2.2
7	m	45	Glomerulonephritis	71	32.1	853	3.8
8	m	78	Glomerulonephritis	61.5	22.7	774	1.8
9	m	70	Diabetes mellitus	66.8	22.9	778	1.8
10	m	80	Hypertension	54	29.3	734	1.8
11	f	38	Nephrotic syndrome	56	21.1	624	5.4
12	m	73	Diabetes mellitus	62	32.4	666	5.1
13	m	72	Hypertension	70.3	24.3	976	5.2
14	m	60	Diabetes mellitus	67	26.5	860	4.5
15	f	67	Pyelonephritis	44	18.2	762	6
16	m	76	Nephrotic syndrome	50	28	725	4
17	m	47	Glomerulonephritis	69	28.7	789	5
18	f	78	Diabetes mellitus	49	26	706	3

Table 2. Serologic parameters for patients receiving heparin during dialysis and with urokinase treatment.

Parameter	Heparin	Urokinase + heparin	p Value
Platelet, × 10^9/L	164.3 ± 52.41	165.3 ± 49.32	0.55
Hemoglobin, g/L	108.6 ± 16.24	110 ± 14.11	0.44
Fibrinogen, g/L	3.65 ± 0.46	3.39 ± 0.84	0.41
PT, s	11.67 ± 1.10	11.37 ± 1.31	0.52
APTT, s	30.77 ± 2.98	31.85 ± 3.94	0.42
D-dimer, mg/L	0.17 ± 0.12	0.16 ± 0.13	0.41

Notes: Values are mean ± SD.

PT, prothrombin time; APTT, partial thromboplastin time.

Figure 1. Prothrombin time (PT), activated partial thromboplastin time (APTT) and D-dimer values pre- and post-dialysis with or without urokinase treatment. (a) PT, (b) APTT and (c) D-dimer pre-dialysis in patients with urokinase was not significantly different from heparin only controls. However, post-dialysis PT and APTT in urokinase treated patients were significantly shorter than in those treated with heparin only (*p < 0.05). D-dimer was markedly higher during dialysis in patients with heparin only than combination treated individuals (*p < 0.05).

Table 3. Costs (per month) of the heparin alone versus heparin + urokinase approaches in patients with hypercoagulable states under dialysis.

	Heparin	Urokinase + heparin	Costs reduction per patient
China yuan (¥)	1298.57	974.25	324.32
US (US$)	189.42	142.11	47.31
Europe (Euros)	122.46	91.88	30.58
Japanese yen (¥)	20497.37	15378.12	5119.25

Notes: The costs include the cost of anticoagulation and dialyzer. The costs are calculated according to the exchanged rate in 2008, when the study started.