Rinsing Dialyzers without Heparin in Hemodialysis (HD) with Low-Molecular Weight Heparin (LMWH)

Abstract

Saline plus unfractionated heparin (UFH) is routinely used for priming dializers before HD start. The aim of this study is to assess if heparin is necessary in pre-rinsing procedure of extracorporeal systems, anticoagulated with LMWH. We carried-out a prospective study in 14 stable HD patients, aged 58.5 ± 3.6 years old. All patients were treated by standard bicarbonate HD, 3 sessions × week, HD time 220 ± 12 min, Qb 276 ± 21 ml/min, low-flux dialyzers (polisulfone 5, cellulose diacetate 9). Clotting was prevented with a single bemiparin (LMWH) bolus 2900 ± 140 IU. Three rinsing protocols were applied in three consecutive weeks: 1st week- Saline 1000 ml + LMWH 2500 IU. 2d week- Saline 1000 ml + UFH 5000 IU. 3th week- Saline 1000 ml. Anti-Xa activity (IU/ml) was measured at each HD (at 10 min/end). Clotting events and post-HD AVF hemostasis were recorded in a semiquantitative scale. No significant statistical differences (Anova) were found in anti-Xa heparin activity (IU/ml) among the three rinsing protocols tested: 10 min (NS) End (NS) 1st week 0.81 ± 0.16 0.55 ± 0.43 2nd week 0.76 ± 0.21 0.58 ± 0.16 3th week 0.86 ± 0.14 0.64 ± 0.16 No differences were observed in drip chamber or dialyzer appearance after HD. Massive clotting was not recorded. No important bleeding was observed at stick needle sites. In conclusion, HD performed with LMWH no needs heparin in rinsing solution. The procedure is effective and safe.