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Hemodialysis without anticoagulation.

P W Sanders, H Taylor, J J Curtis

    American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    |January 1, 1985
    PubMed
    Summary
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    Hemodialysis can be performed without heparin, even in high-risk patients. This approach avoids bleeding complications associated with heparin anticoagulation during dialysis.

    Area of Science:

    • Nephrology
    • Hematology

    Background:

    • Heparin is a standard anticoagulant for hemodialysis.
    • Heparin use increases bleeding risk in high-risk patients, potentially leading to morbidity and mortality.

    Purpose of the Study:

    • To evaluate the safety and efficacy of heparin-free hemodialysis in patients at high risk of bleeding.
    • To assess complications such as bleeding and circuit clotting during heparin-free dialysis.

    Main Methods:

    • A prospective study involving 156 heparin-free hemodialysis procedures over one year.
    • Twenty-eight patients were included, with 23 post-renal transplant and five undergoing procedures like dental extraction or parathyroidectomy.
    • Monitoring for bleeding complications and circuit clotting (complete or partial).

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    Main Results:

    • No bleeding complications were observed during or after heparin-free dialysis procedures.
    • No induced or aggravated coagulopathy was noted.
    • Significant circuit clotting occurred in 5.13% of procedures, with an average blood loss of 150 ml.
    • Partial clotting occurred in 5.8% of procedures without interrupting dialysis.

    Conclusions:

    • Heparin-free hemodialysis is a safe and effective alternative for patients at high risk of bleeding.
    • The complication rates observed are comparable or favorable to those reported for low-dose or regional heparin protocols.
    • This strategy can reduce the risks associated with heparin anticoagulation in specific patient populations.