Dialysate … Ho-Hum!

Abstract

Dialysate is not considered a worthwhile area of inquiry for nephrologists in the United States. That could be the message from nephrology training programs that claim trainees receive sufficient dialysis instruction during their clinical rotations so that specific dialysis training is optional or from the paucity of abstracts on improved dialysis techniques submitted to the American Society of Nephrology annual meetings. This lack of interest in dialysate might be understandable if there had been breakthroughs in alternative therapies, but given such lack of progress, improving routine hemodialysis (HD) should get more attention. One area of routine outpatient HD in which there has been little progress in 30 yr is keeping the extracorporeal circuit patent without the need for systemic anticoagulation with heparin (regional citrate anticoagulation is primarily an in-patient procedure). Minimizing the use of heparin is important for several reasons: ( 1 ) More HD patients are using drugs such as warfarin, aspirin, or clopidogrel; ( 2 ) the increasing use of arteriovenous fistulas or grafts means more puncture sites that can bleed during and/or after HD; ( 3 ) larger needles are required to accommodate higher blood flow rates; ( 4 ) dialysis unit staff are busier than ever, increasing the risk for heparin dosing errors and leaving …