Improved dialyzer reuse after use of a population pharmacodynamic model to determine heparin doses

Anticoagulation with heparin is performed to prevent clotting during dialysis. However, heparin doses are usually determined empirically, and dialyzer clotting is a common reason for discarding reused dialyzers. We hypothesized that using a population pharmacodynamic model to determine individual heparin doses would improve dialyzer reuse rates. A previously published model was used to determine the loading dose and infusion rate of heparin needed to increase the intradialytic whole-blood clotting time to 150% of the predialysis value. The effectiveness of the model was assessed by comparing dialyzer reuse rates and delivered Kt/V(urea) before and after implementation of the model in 22 chronic hemodialysis patients. As an additional control, a similar group of 22 patients were followed up during the same period without adjustment of their heparin doses. Implementation of the model resulted in no change in the average loading dose (2,382 +/- 628 versus 2,425 +/- 908 IU; P = not significant) or average infusion rate (1,398 +/- 367 versus 1,393 +/- 532 IU/h; P = not significant) of heparin. However, individual patients required changes in loading dose or infusion rate. Dialyzer reuse rates increased significantly over time in the treatment group but remained unchanged in the control group (P < 0.003). Kt/V(urea) remained unchanged throughout the study period in both patient groups. From these data, we conclude that the use of a heparin model can improve dialyzer reuse rates without compromising the delivered dose of dialysis.