The Effect Of Low Molecula Weight Heparin On Secondary Hyperparathyroidism In Dialysis

Secondary hyperparathyroidism (Secondary hyperparathyroidism SHPT) is a common complication of uremic patients, especially prevalent in the hemodialysis patients, mainly due to lower blood calcium by the lack of the active vitamin D3, hyperphosphatemia,1,25-(OH) 2D3 resistance when CRFMainly as follows: stimulated hypertrophy of parathyroid glands, parathyroid hormone caused by various factors (PTH) levels, while PTH is a uremic toxin that can cause impaired glucose tolerance in uremic patients, nervous system diseases Renal bone disease, hyperlipidemia and skin itching, cardiovascular disease and other clinical complications, caused great suffering to patients, and even life-threatening·The current method of treatment of SHPT include:calcium supplement and calcium receptor agonists, the use of phosphate binders, active vitamin D applications as well as surgical treatment, have achieved good clinical results·Chronic kidney disease Widespread of oxidative stress, oxidative stress is an increase in reactive oxygen species and antioxidant capacity decreased, causing the body to some extent of damage·Oxidative stress in chronic kidney disease risk factors, can cause kidney damage and a variety of complications.Low molecular weight heparin and unfractionated heparin compared with fewer side effects, and have antioxidant, anti-inflammatory, reducing proteinuria and cholesterol, and other effects, is gradually replacing unfractionated heparin as a major clinical anticoagulant.Test proved that low molecular weight heparin has a strong antioxidant capacity, oxidative stress can reduce the product retention, reduced oxidative stress damage to the patient.vitamin D Combinate to vitamin D receptor (VDR) Can play a role. AGEs are products of oxidative stress, AGEs is caused by 1,25 (OH) 2-D3 resistance to a toxin, the mechanism for the reduction of the VDR, inhibited 1,25 (OH) 2-D3 receptor bindintg, inhibition of Nuclear uptake of 1,25 (OH) 2-D3 complex, and the combination of suppression and genetic components.In this experiment, we adopted the long-term dialysis patients in the low molecular weight heparin and unfractionated heparin conventional anticoagulation was observed between patients on maintenance hemodialysis with secondary hyperparathyroidism influence to guide clinical practice of secondary Hyperparathyroidism in the control and prevention.Objective:To comprehend the effect of low molecular weight heparin on secondary hyperparathyroidism in patients on maintenance hemodialysis(MHD).Methods:Choice of blood purification center in our hospital's 94 patients MHD, heparin treatment group were randomly divided into normal (A group of 43 patients), of which 23 males,20 females, aged 11 to 70, mean age (45.1±9.3) years The average age of dialysis (31.3±10.2) months; low molecular weight heparin group (B group 51 patients), including 27 males,24 females, aged 11 to 70 years, mean age (43.9±12.1) years, mean dialysis age (28.2±10.6) months. Primary disease: diabetic nephropathy in 26 cases,33 cases of nephritis, hypertensive nephropathy in 18 cases,14 cases of obstructive nephropathy, polycystic kidney disease in 3 cases. All patients had stable disease, hemodialysis more than six months, no significant bleeding tendency; dialysis three times a week, every 4h, dialysis adequacy, is not used within 2 months of intestinal phosphate binders, calcium or calcitriol therapy experiment to maintain the other medications, including antihypertensive drugs, folic acid, erythropoietin, etc., but not intestinal phosphate binders, calcium or calcitriol and other drugs. Exclude low molecular weight heparin allergy, patients with severe bleeding, severe infections, liver and gallbladder diseases, cancer or autoimmune disease activity and periods of time.Results:1.two groups of patients before treatment serum calcium, phosphorus, calcium and phosphorus product, PTH, AKP, AGEs, AOPP levels were no significant differences (P> 0.05)2. A group test after 6 months serum calcium, phosphorus, calcium and phosphorus product, AKP, no significant changes, iPTH, AOPP, AGEs,increased slightly, the difference was not statistically significant (P> 0.05); B group test after 6 months serum calcium, phosphorus, calcium and phosphorus product, AKP difference not statistically significant (P> 0.05), AOPP, AGEs,iPTH, decreased, the difference was statistically significant (P<0.05).Conclusions:Prevalence of long-term dialysis patients oxidative stress, long-term use of low molecular weight heparin anticoagulation, hemodialysis can oxidative stress in patients with partial remission, iPTH decreased, suggesting that low molecular weight heparin can improve the secondary hyperparathyroidism hyperthyroidism.