Clotting rate just 1% with anticoagulant-free hemodialysis method

By Reuters Staff

NEW YORK (Reuters Health) - An anticoagulation-free hemodialysis (HD) protocol can be performed in patients with any HD access type, with "essentially no circuit clotting," according to a new study.

While anticoagulant use is not usually a concern for outpatients receiving HD, inpatients may have comorbidities that make anticoagulation problematic, Dr. Sheena Sahata and Dr. Roger Rodby of Rush University Medical Center in Chicago note in their report, published online October 30 in the Clinical Kidney Journal.

In 2000, the authors add, they developed a HD protocol using "aggressive intradialytic normal saline flushing" to avoid anticoagulation. Rush has been using this protocol in all inpatients requiring dialysis since 2008. The protocol involves priming the dialysis circuit with normal saline to remove any air, maximizing blood flow during HD up to 400 mL/min, flushing the dialysis circuit every 15 minutes with 100 mL of normal saline, and using bloodlines without a blood-air interface.

The authors performed a retrospective chart review of adult inpatients treated with HD at their center from December 2012 to October 2013. Most of the 400 patients included in the review had end-stage renal disease. Forty-five percent had catheter HD access, 40% had native AV fistulas, and 15% had grafts.

The researchers looked at the first HD treatment of each patient's hospitalization. Clotting of the hemodialyzer circuit occurred during four (1%) of the 400 treatments included in the analysis.

The rate of clotting was lower than the 2% to 5% seen in other studies of anticoagulation-free HD, the authors note. "While 5% clotting may be acceptable in high risk patients, 1% clotting makes this strategy very attractive to use as a default in all patients regardless of any underlying conditions that may make them 'high risk,'" the authors write.

"We believe our data support our anticoagulation-free protocol utilizing high blood flows, frequent large volume NS flushes and even 'airless' bloodlines, as an excellent option for all adult inpatient HD treatments," they add. "This strategy appeared to be successful across all access types with essentially no clotting of the HD circuit. The effect of this regimen on dialyzer function is not known."

Dr. Rodby did not respond to an interview request by press time.

SOURCE: http://bit.ly/1xVWwir

Clin Kidney J 2014.

(c) Copyright Thomson Reuters 2014. Click For Restrictions - http://about.reuters.com/fulllegal.asp