Prospective Study of Routine Heparin Avoidance Hemodialysis in a Tertiary Acute Care Inpatient Practice.

Area of Science:

• Nephrology
• Critical Care Medicine
• Vascular Access

Background:

• Heparin anticoagulation in extracorporeal circuits (EC) for hemodialysis (HD) poses bleeding risks for inpatients.
• Alternative anticoagulation strategies are needed for acute care inpatient HD.

Purpose of the Study:

• To evaluate a heparin-avoidance HD protocol in acute care inpatients.
• To assess the rate of extracorporeal circuit clotting (CEC) and its impact on dialysis efficiency.
• To identify risk factors associated with CEC.

Main Methods:

• Prospective evaluation of 1200 HD sessions using airless dialysis tubing without routine EC heparin.
• Systemic anticoagulation and antiplatelets were administered for non-HD indications.
• CEC was defined as interrupted sessions, circuit loss, or inability to return blood.

Main Results:

• The EC clotting rate was 5.2% in the heparin-avoidance protocol.
• Temporary catheters and transfusions were associated with increased CEC risk (OR 2.8 and 2.4, respectively).
• Therapeutic systemic anticoagulation and antiplatelets were protective against CEC (OR 0.2 and 0.4, respectively).
• CEC was associated with a lower delivered dialysis dose (Kt/V).

Conclusions:

• Heparin avoidance with airless HD tubing is a feasible and safe inpatient protocol.
• Low CEC rates were observed, linked to temporary catheters and transfusions.
• Systemic anticoagulation and antiplatelets demonstrated a protective effect against CEC.