SAT-230 Comparison between Nurse Assisted Home Hemodialysis (NAHHD), and in Center Hemodialysis (CHD), in home bound, multi comorbid, and debilitated hemodialysis patients

Abstract

its use will prevent a large number of patients from unnecessary exposure to systemic antibiotics, hence reduce the development of antibiotic resistance and the economic impact of using long term prophylactic systemic antibiotics.Introduction: Background: LMWHs are available since 30 years with wide use in the treatment and prevention of medical and surgical thromboembolic events. The use of LMWHs as anticoagulant in hemodialysis (HD) patients is still not a routine or standard practice. We are using LMWH 'Enoxaparin" since 1998 as a standard anticoagulation in our HD unit, and in a previous publication (1), we found that dose of enoxaparin required in our HD patients, is only the 1/3 of the recommended dose, which was (0.36 mg/kg) Aim of the study: In the current study, we are reporting our 15 year experience of using "Enoxaparin", evaluating following points: the current used dose, the dose according to the type of vascular access, etiology of kidney disease (diabetic, none diabetic), and dialytic mode (HD, HDF) Methods: This study includs 252 HD patients, mean age 56.6 (17) year, Male 145 (57.5 %). Mean duration on HD 50 (44.5) months. 139 (55%) were diabetics, 138 (55%) had AVF, 28 (11%) had AVG, and 86 (34%) had tunneled catheter(TC). 187 (74%) patients were on HD, and 65 (26%) were on line HDF. Results: Total number of HD sessions during the 15 years use of " Enoxaparin" was 350,000. The average dose of " Enoxaparin" was 0.31 (0.14) mg/kg/session. 0.29 (0.13), 0.34 (0.17), and 0.34 (0.14) mg/kg/ session, were the average doses used in AVF, AVG, and TC respectively with p¼0.03. The dose used in DM patients was 0.30 (0.13), and 0.34 (0.13) mg/kg in non DM, withp¼0.15. Average dose in HD was o.31 (0.13), and in HDF 0.32 (0.15) mg/kg, p¼0.69 Conclusions: To the best of our knowledge this study is the longest, and the largest experience ever reported with the use of LMWH " Enoxaparin" as a standard anticoagulant in HD. The average dose used continued to be low and stable with time. Only the type of vascular access impact significantly the required dose.