Clinical experience with nadroparin in patients undergoing dialysis for renal impairment

Dialysis procedures are life-sustaining renal replacement therapies indicated for patients with limited or no kidney function. The formation of clots in the extracorporeal circuit during dialysis is an undesirable event. Anticoagulation is therefore routinely practiced in this context. Unfractionated heparin (UFH) is largely used in dialysis patients. However, except in patients with an elevated risk of bleeding, the 2002 European Best Practice Guidelines Expert Group on Hemodialysis recommended the use of low-molecular-weight heparins over UFH, in view of their equal efficacy, improved safety, and easy handling. Low-molecular-weight heparins comprise several drugs, differing in a number of pharmacological and clinical properties. This manuscript reviews the data obtained with nadroparin, a low-molecular-weight heparin studied extensively in dialysis patients. Thus, several studies investigated the benefit of nadroparin vs. UFH, other low-molecular-weight heparins, or citrate in patients undergoing intermittent hemodialysis. Overall, they showed that a single intravenous bolus dose of nadroparin, adjusted according to body weight, was effective and safe for maintaining the patency of the extracorporeal circuit during intermittent hemodialysis sessions lasting up to 6 hours, in both adults and children with end-stage renal failure. In contrast to UFH, nadroparin required no laboratory monitoring of anticoagulant activity owing to the reliable anticoagulant response following its administration. Compared with UFH, nadroparin was beneficial in terms of lipid and possibly bone parameters. Nadroparin administered by a bolus dose, followed by a continuous infusion was also shown to be effective and safe in patients undergoing continuous renal replacement therapy for acute renal failure.