Hemodialysis without anticoagulation

Schwab, Steve J.; Onorato, James J.; Sharar, Linda R.; Dennis, Patricia A.

doi:10.1016/0002-9343(87)90748-0

Cited by 80 publications

(11 citation statements)

References 15 publications

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“…Coagulation in the circuit has been reported with a variable frequency, 5 to 50%, with early termination of the dialysis session in 5 to 7% [2-7]. Mean treatment duration varied between 3 and 4 hours [2,3,5,6]. Previous reports documented preserved clearance efficiency in haemodialysis using intermittent saline flushes [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Mean treatment duration varied between 3 and 4 hours [2,3,5,6]. Previous reports documented preserved clearance efficiency in haemodialysis using intermittent saline flushes [2,4,5]. The recent prospective and randomized HepZero study in maintenance dialysis patients has shown that only half of the 127 patients in the control group, receiving saline flushes of 100–300 ml every 30 minutes or predilution infusion of 1–2 litres per hour in haemodiafiltration, were able to complete 4 hours of dialysis without reaching one of the clotting-related events of the composite endpoint [7].…”

Section: Introductionmentioning

confidence: 99%

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Avoidance of systemic anticoagulation during intermittent haemodialysis with heparin-grafted polyacrilonitrile membrane and citrate-enriched dialysate: a retrospective cohort study

et al. 2014

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BackgroundSince October 2010, the combination of a heparin-grafted polyacrilonitrile (AN69ST) membrane with a 0.80 mmol/L citric acid-containing dialysate is routinely used in our centre for intermittent haemodialysis, without systemic anticoagulation, in critically ill patients with increased bleeding risk. The primary outcome of this retrospective cohort study was to assess the development of circuit clotting during these dialysis procedures. Secondly, we assessed the impact of clotting on treatment duration, the incidence rate of coagulation-induced retransfusion failure and the association of patient and dialysis characteristics with the occurrence of clotting.MethodsDialysis and patient data on consecutive intermittent haemodialysis procedures, performed at the Intensive Care Unit of Universitair Ziekenhuis Brussel between October 2010 and March 2012, were retrospectively reviewed. We used descriptive statistics as well as a random effects logit model with patient identity as a panel variable to assess associations.ResultsOf a total of 309 treatments combining a heparin-grafted AN69ST membrane and a 0.8 mmol/L citric acid-enriched dialysate in 94 patients, circuit clotting was reported in 17.5% (95% CI 13.2% to 21.7%; N = 54), and in 19% (95% CI 13.6% to 24.4%; N = 40) of sessions with prescribed treatment time ≥ 4 hours (N = 210). Clotting shortened treatment time in 15.2% (95% CI 11.4% to 19.7%; N = 47) of sessions by a median of 55 (IQR 20 to 80) minutes. Complete clotting of the circuit with inability for retransfusion occurred in 4.2% (95% CI 2.2% to 7.0%; N = 13) of sessions. Circuit coagulation was not associated with APACHE II score, patient age, gender, number of treatments, type of vascular access or ultrafiltration rate.ConclusionIntermittent haemodialysis without systemic anticoagulation combining a heparin-grafted AN69ST dialyzer with a citrate-enriched dialysate favourably compares as to clotting complications with the published outcomes of anticoagulation-free intermittent haemodialysis strategies using saline flushes, heparin-coated dialyzer in combination with regular dialysate or regional citrate anticoagulation with calcium supplemented dialysate. The incidence of circuit clotting in our cohort appears to be higher than previously reported for regional citrate anticoagulation with a calcium-free dialysate.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Avoidance of systemic anticoagulation during intermittent haemodialysis with heparin-grafted polyacrilonitrile membrane and citrate-enriched dialysate: a retrospective cohort study

et al. 2014

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“…[1][2][3][4][5][6][7] Saline rinses with up to 5-7 L have been reported. [2][3][4][5][6][7] Other protocols for heparin-free hemodialysis (HF-HD) have administered heparin in a priming solution, which may be rinsed away with saline, or administered to the patient. [4][5][6][7] HD has evolved in many ways since then.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7] Other protocols for heparin-free hemodialysis (HF-HD) have administered heparin in a priming solution, which may be rinsed away with saline, or administered to the patient. [4][5][6][7] HD has evolved in many ways since then. Hollow fiber membranes composed of many new synthetic compounds have replaced cellulose parallel-plate and coil dialyzers.…”

Section: Introductionmentioning

confidence: 99%

“…Although initial reports of HF-HD suggested that catheter locking did not result in systemic anticoagulation, [1][2][3][4] little data have been presented that supports this conclusion. Previous work shows that anticoagulation clearly oc-curs when catheter injection exceeds the known volume of the lumina 15,16 for up to 10 min after catheter locking.…”

Section: Introductionmentioning

confidence: 99%

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Clinical consequences of heparin‐free hemodialysis

McGill

Blas

Bialkin

et al. 2005

Hemodialysis International

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Heparin-free hemodialysis (HF-HD) has been increasingly used in patients at risk for bleeding, especially in the intensive care unit (ICU). Lack of heparin can reduce solute clearances in continuous hemofiltration; the effect on HD is undefined. Failure to recognize an effect of the anticoagulation strategy upon delivered clearance could contribute to the known problem of underdialysis in the ICU. In addition, the consequences of "locking" dialysis catheters with concentrated heparin solutions are also unclear. This study was designed to define the clinically relevant consequences of HF-HD and catheter locking. In part I, we performed 200 HD treatments on inpatients, of which 100 were performed with heparin, and 100 were performed as HF-HD. We calculated prescribed and delivered Kt/V and dialysis efficiency. In part II, a separate group of 14 patients undergoing HF-HD via central venous catheters had measurement of activated partial thromboplastin time (aPTT) during the last hour of dialysis, as well as 15, 60, and 240 min after catheters were locked with 1:5000 heparin. The prescribed Kt/V was 1.74+/-0.31 for standard HD with heparin vs. 1.66+/-0.36 for HF-HD (p=ns). The delivered Kt/V was 1.42+/-0.32 vs. 1.36+/-0.38 (p=ns). Efficiency was 0.82 vs. 0.84 (p=ns). Baseline aPTT was 28+/-5 s, and increased to 126+/-54 s, 15 min after locking (p<0.0001) and to 71+/-50 s, 60 min after locking (p=0.005). By 240 min, the mean aPTT had fallen to 33+/-9 s (p=0.03), although individual values were still as high as 50 s. The HF technique does not compromise delivery of dialysis to inpatients. Increased treatment time is not necessary. Locking catheters with heparin after HF-HD resulted in prolonged unintentional anticoagulation.

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Procedures in Critical Care: Dialysis and Apheresis

Diamond¹,

Szerlip

2010

Bedside Procedures for the Intensivist

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Hemodialysis without anticoagulation

Cited by 80 publications

References 15 publications

Avoidance of systemic anticoagulation during intermittent haemodialysis with heparin-grafted polyacrilonitrile membrane and citrate-enriched dialysate: a retrospective cohort study

Avoidance of systemic anticoagulation during intermittent haemodialysis with heparin-grafted polyacrilonitrile membrane and citrate-enriched dialysate: a retrospective cohort study

Clinical consequences of heparin‐free hemodialysis

Procedures in Critical Care: Dialysis and Apheresis

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