SP469HEMODIALYSIS IN ADULTS WITHOUT ANTICOAGULATION

Abstract

INTRODUCTION AND AIMS: Hemodialysis therapy of patients at increased risk of bleeding is a well-known clinical problem. Systemic anticoagulation with heparin increases the risk of severe hemorrhage. Alternative strategies include the use of heparin-coated dialysis membranes, regional heparin anticoagulation with protamine reversal, regional citrate anticoagulation, airless dialysis tubing and flushing the dialyzer with saline. However, these techniques are complex, and require additional time and personnel resources for administration and monitoring. Current data on heparin-free dialysis are rare. We reviewed 158 dialysis protocols of hospitalized and outpatient dialysis patients who were treated without systemic or regional anticoagulation due to an increased risk of bleeding or a manifest hemorrhage. The duration of each dialysis session and the number of dialyses with or without clotting were evaluated. METHODS: 158 dialysis sessions of 69 patientswere reviewed. Therapywas performed with Fresenius 4008/5008 (FX80) andGambro Artis (Poly170H). All dialyses were performed as double-needle or via double-lumen central venous catheters (requested blood flow min.>200ml/min).No additional technical devices or procedures were used beside standard hemodialysis or hemodiafiltration. Some of the patients showed coagulopathies (vitamin K antagonists,DOAKs, sepsis) or thrombocytopenia (liver cirrhosis). RESULTS: In 16 cases (10.1%) systemic clotting made a discontinuation of the dialysis session necessary. In 5 of 158 cases (3.2%), the dialysis treatment had to be continued with new tubing and filter. More than one change was never necessary. In the other 11 cases, the dialysis has to be discontinued with retransfusion 10 minutes until 1 hour before the scheduled end of therapy, and therapy was considered as sufficient. The frequency of clotting did not correlate with dialysis time (Fig.1). CONCLUSIONS: Dialysis without anticoagulation can be performed routinely with modern synthetic filters. Patients at high risk of bleeding or with manifest hemorrhage can undergo dialysis treatment for up to five hours without complications. In the present study clotting did not correlate with dialysis time. Patient-specific factors seem to play amore important role. In summary additional cost intensive devices or personnel intensive procedures are only rarely needed to perform heparin-free dialysis for patients at risk (Figure presented).