P1119ASSOCIATION OF VARIOUS RISK FACTORS WITH HEMODIALYZER SET CLOT INCIDENCES WHEN USING LOW DOSE UF- HEPARIN OF 400 IU BOLUS AND 400 IU INFUSION IN MAINTENANCE DIALYSIS SESSION : A CASE CONTROL STUDY

Abstract

Abstract Background and Aims Efforts were made in the past to reduce the use of heparin as anticoagulation to escape from the its Sid effects like Bleeding and HIT among others. We use Low dose UF -heparin use with bolus of 400 IU and 400 IU/hour infusion as an anticoagulation in hemodialysis patients. Set clot incidences were comparable to other studies. The objectives of this study is to see aassociations of different risk factors with hemodialyzer set clot incidences using Low dose heparin Infusion protocol in maintenance haemodialysis session. Method Data were obtained from the outpatient haemodialysis unit at tertiary care Hospital in Karachi, Pakistan. UF-low dose heparin 400 I.U bolus and 400 I.U maintenance infusion protocol were given to all patient. Case to control ratio was approximately 1:4. 300 cases of set clot were taken and 1200 control sessions without set clot outcome were matched for heparin use taken from the dialysis unit. The crude odds ratios (OR’s) and adjusted ORs (aORs) for various risk factors were obtained using conditional logistic regression. Results In a prelimary part of the study the incidence of set clot was 7% (309/4000 sessions) Age, dialysis vintage, hemoglobin level, Blood flow rate and type of anti-platelet therapy were significantly associated to the incidence of set clot. Among patients having age > 40 yrs. the odds of set clot were 2.8 (95% CI= 1.8-4.3) as compare to the patients with age ≤ 40 yrs. The odds of set clot were 0.268(95% CI=0.081-.88) among patients with hemodialysis vintage less than 1 year as compare to those who have more than 1 year. Blood flow rate <350 ml/min have an odds of 1.03(95%CI=0.76-1.40) of set clot incident as compare to BFR>350 ml/min. Those patients with Hemoglobin < 9 gm/dl have odds of set clot of 0.67(95%CI =0.48-0.92) as compare to hemoglobin > 9 gm/dl. Off all patients ,60.36% patients were either on aspirin or clopidogrel while around 9.58% were on combine antiplatelets therapy. The odds of set clot were 4.6 (95% CI =1.9-10.8) among patients on Combine antiplatelet therapy as compare to no antiplatelet therapy. Conclusion Age, low Blood flow rate and combine antiplatelet therapy (aspirin and clopidogrel) are positively associated with set clot accidents in dialysis sessions. Dual anti platelet therapy patients are given in ischemic heart disease patients hence Blood flow pumps are kept at lower speed which can increase the risk of set clot. Lesser duration on Hemodialysis (i.e. less than 1 year) and low hemoglobin levels are protective for incidence of set clot in our study population.