To cite this article: Schmid P, Brodmann D, Fischer AG, Wuillemin WA. Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal function. J Thromb Haemost 2009; 7: 552-8.Summary. Background: Low-molecular-weight heparins (LMWH) have been shown to be effective and safe for prophylaxis of thromboembolic diseases. However, issues regarding safety and optimal use of LMWH arise in patients with renal insufficiency (RI). Objectives: To compare pharmacokinetic data of dalteparin for up to 3 weeks in patients with various degrees of RI. Patients and methods: Patients from general medical and surgical wards were included in this prospective cohort study and divided into three groups according to renal function: A = normal (GFR ‡ 60 mL min m )2). Dalteparin was injected s.c. once daily at a prophylactic dose. Peak anti-Xa activity levels (anti-Xa) were measured 4 ± 1 h after injection on day 1 and every third day up to 3 weeks. Primary objectives were peak anti-Xa levels and adjusted anti-Xa levels, adjustment being carried out for dose and body weight. Results: A total of 42 patients could be analyzed during a median of 10 days . In all groups, adjusted peak anti-Xa levels were not different on day 10 compared with day 1. No bioaccumulation >30% could be found up to day 10 even in patients with severe RI. Conclusion: The use of dalteparin at a prophylactic dose was not associated with a bioaccumulation >30% even in patients with severe renal insufficiency during a median follow-up of 10 days (IQR 4-13, range 1-20).

To cite this article: Schmid P, Brodmann D, Odermatt Y, Fischer AG, Wuillemin WA. Study of bioaccumulation of dalteparin at a therapeutic dose in patients with renal insufficiency.

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the acute DVT event, while 31% of the patients still had an abnormal CUS examination. This study indicates that MRDTI may potentially be an accurate method to distinguish a new recurrent event from an old thrombus in patients with acute suspected RDVT. However, this has to be evaluated in prospective management studies.In conclusion, this study showed that the use of the established diagnostic criteria of CUS is less clinically applicable in the daily diagnostic work-up of suspected ipsilateral RDVT. The associated high percentage of non-diagnostic CUS and related overdiagnosis and overtreatment indicates the urgent need for more accurate diagnostic methods and strategies in patients presenting with suspected ipsilateral RDVT. AcknowledgementsThis study has been funded by the Netherlands Heart Foundation. Grant number 2007B146. Disclosure of Conflict of InterestsThe authors state that they have no conflict of interest. Prospective observational cohort study of bioaccumulation of dalteparin at a prophylactic dose in patients with peritoneal dialysis

Zusammenfassung Hintergrund Mangelernährung ist sowohl in der Normalbevölkerung als auch bei Dialysepatienten häufig. Je nach untersuchtem Parameter sind ca. 20 – 60 % der Dialysepatienten von dieser – bei dieser Patientengruppe Protein-Energy-Wasting (PEW) genannten – Erkrankung betroffen. Methoden Literaturreview der aktuellen Leitlinien, Studien und Metaanalysen. Ergebnisse Nach Diagnosestellung stellt neben der Minimierung Mangelernährung begünstigender Faktoren wie z. B. chronischer Infekte, Schluckstörungen, sozialer Ursachen und viele mehr die Steigerung und Sicherstellung der Kalorien- und Eiweißzufuhr eine große Herausforderung bei diesen meist schwachen und appetitlosen Patienten dar. Die Möglichkeiten zur Optimierung der Ernährung während der Hämodialyse (intradialytische Ernährung) umfassen neben der Bereitstellung einer hochwertigen und möglichst eiweißreichen Mahlzeit zur Minimierung der Katabolie die Anreicherung der Nahrung mit Maltodextrin oder Eiweißkonzentraten, die IDEE (intradialytische enterale Ernährung) und die IDPE (intradialytische parenterale Ernährung). Jedoch stellt die Hämodialyse mit 3-mal pro Woche jeweils 4 Stunden nur einen geringen Zeitanteil am Leben des Patienten dar. Ernährungsmaßnahmen allein während der Dialyse sind deshalb nicht ausreichend und müssen um Maßnahmen für die Zeit außerhalb der Dialysen ergänzt werden.