Hemodialysis without anticoagulants: efficiency and hemostatic aspects

Area of Science:

• Nephrology
• Hematology

Background:

• Patients with high bleeding risk often require anticoagulation during hemodialysis.
• Anticoagulation can increase bleeding complications.
• Alternative dialysis methods are needed for this patient group.

Purpose of the Study:

• To compare the safety and efficacy of WHD versus LDHD in patients with high bleeding risk.
• To evaluate the risk of clotting and bleeding complications with WHD.
• To assess the impact of WHD and LDHD on hemostasis variables.

Main Methods:

• 111 WHDs and subsequent LDHDs were performed in 29 high-risk patients.
• Dialyzer clotting was monitored.
• Urea and creatinine clearances were measured to assess efficacy.
• Hemostasis variables (fibrinogen, platelets, ATIII, PT, PF4, FPA) were analyzed in a subset of patients.

Main Results:

• Partial clotting occurred in 11 dialyzers and 20 drip chambers during WHD, but not during LDHD.
• No significant difference in urea and creatinine clearances was observed between WHD and LDHD.
• Platelet factor 4 (PF4) levels increased during both WHD and LDHD.
• Plasma fibrinopeptide A (FPA) levels significantly increased during WHD but remained normal during LDHD.

Conclusions:

• WHD is a feasible alternative for hemodialysis in patients with high bleeding risk.
• WHD has a low risk of extravascular coagulation and does not increase bleeding risk.
• The risk of intravascular coagulation during WHD is low, as indicated by isolated FPA elevation without changes in other markers.