Hemodialysis for patients bleeding or at risk for bleeding, can be simple, safe and efficient

Hemodialysis for patients bleeding or at risk for bleeding requires special modalities of treatment that are difficult to perform without potential side effects. A simple, safe and adequate method may be applied.

A modified way of extracorporeal circuit preparation, which focuses on minimizing the blood-air interface and negligible saline flushing of 50 ml/h, is applied for a maximum of 3-hour session with routine (not one-to-one) nursing attendance. Data from 16,954 sessions performed with patients bleeding or at risk for bleeding (15,730 retrospectively and 1,224 prospectively collected) were analyzed.

Cumulative failure of treatment, as defined by clotting of the extracorporeal circuit requiring termination of the procedure or replacement of the clotted part, was not more than 5% as expected for anticoagulation-free hemodialysis. For the prospectively recorded sessions, blood flow was 234 +/- 30 ml/min with less than 250 ml/min in 42.4% of the sessions. Native blood access was used in 426 (34.8%), double-lumen catheter in 798 (65.2%), 42 were isolated ultrafiltration sessions and 64 blood, 21 plasma, 9 platelet units were transfused. Post/pre urea ratio was 0.50 +/- 0.12. Logistic regression showed that among the following: duration of the session, type of dialysis, ultrafiltration rate, hematocrit, number of platelets, serum total protein, transfusions, blood flow and type of access, only blood flow significantly affected failure incidence (coefficient B = -0.041, exp(B) = 0.96, p = 0.04). No complications due to treatment were noted.

In patients with active, or at risk for, bleeding, hemodialysis without systemic anticoagulation can be adequately and safely performed almost as a routine session.