Low-dose and heparin-free hemodialysis in children

Abstract

Successful heparin-free hemodialysis has been reported in adults but not in children. A preliminary study was carried out to determine whether heparin-free hemodialysis was possible in children who were considered to have a high risk of bleeding, and if so, to identify the children in whom this technique might be expected to succeed. Of 28 heparin-free procedures, 21 (75%) were successful, a major clot developed in 4, and a minor clot occurred in 3. These children were 6.76 +/- 4.57 years old and weighed 20.7 +/- 11.3 kg. An activated clotting time (ACT) of less than 170 s was recorded in five of the six patients in whom clotting was observed (normal value 146 s with a range of 110-180 s). In a second prospective study, low-dose heparin was prescribed for patients with an ACT of less than 170 s, while the remaining children again underwent heparin-free dialysis. In this study only those patients with double-lumen vascular access and a predialysis systolic blood pressure greater than 80 mmHg were included. Their mean age was 12.25 +/- 4.61 years and their weights 32.9 +/- 19.3 Kg. In 28 of 31 (90%) procedures, no clotting was observed. Minor clotting developed during the remaining 3 procedures, all in one child who weighed 8.5 kg (the only child weighing less than 10 kg). Heparin (9.6 +/- 3.2 IU/kg body weight per hour) was administered during 18 successful procedures. This study shows that heparin-free hemodialysis is possible in children, particularly, but not exclusively, those with a coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Heparin Therapy in Pediatric Patients

“…One approach is to administer a bolus with 50 U/kg initially and adjust a continuous infusion of heparin based on the ACT. 119 Target values for ACTs vary with some reports suggesting values over 220 seconds and others suggesting lower values between 180 and 220 seconds. 119 Another approach is to use regional heparinization to maintain an ACT between 180 and 200 seconds in the extracorporeal circuit.…”

“…119 Target values for ACTs vary with some reports suggesting values over 220 seconds and others suggesting lower values between 180 and 220 seconds. 119 Another approach is to use regional heparinization to maintain an ACT between 180 and 200 seconds in the extracorporeal circuit. 119 The ACT is held below 120 seconds in the patient's circulation.…”

“…119 Another approach is to use regional heparinization to maintain an ACT between 180 and 200 seconds in the extracorporeal circuit. 119 The ACT is held below 120 seconds in the patient's circulation. Heparin-free dialysis has also been used for some adults with a clotting rate of 7 to 20%.…”

Alternatives to standard unfractionated heparin for pediatric hemodialysis treatments

“…In addition, some centers circulate heparinized saline (UFH 5,000–20,000 IU) for up to an hour prior to dialysis, to allow UFH binding to the dialyzer and circuit, and then the heparinized solution is rinsed out before dialysis is started [26]. Higher blood pump speeds (> 300 ml/min) and cooled dialysate (at 20°C) also reduce the risk of clotting [27], whereas the risk of clotting is increased in infants < 10 kg with slower blood flows [28]. …”

Clinical Study of Heparin-Free Hemodialysis with the Inside of Hollow Fibers in Dialyzer Coated by Human Albumins

“…At present, it is thought that heparin-free HD (HFHd) with hollow fibers in a dialyzer with normal saline (NS) flush (HFHd-NS) is an effective and feasible method which could treat these patients [2, 3]. But there are still shortcomings in the HFHd-NS method: (1) An excess of NS as infused into the patient during the HFHd-NS period, so that the fluctuation of cardiac anterior load in the patient was increased, which was not advantageous for HD in patients with cardiac insufficiency or fluid overload.…”