Table 4:
Studies
evaluating extracorporeal circuit clotting in heparin-free hemodialysis.
|
Author, year (reference #) |
Patient Acuity
(N) |
HD
procedures (N) |
HD
circuit priming type |
Outcomes Defined |
Results |
|
Glaser, 1979 [9] |
High risk Patients (185) |
H-HD 520 H + HD 529 |
Saline and gelatin
solution |
HD circuit clotting (unspecified) |
H-HD 9.6% H + HD 6.9% P = NS |
|
Raja, 1980 [2] |
Low risk patients (14) High risk patients (19) |
H-HD 14 H-HD 50 |
Heparin 1500 units and
saline |
Post-HD FBV Visual appearance post HD |
FBV loss 18% P < 0.01 None 10% Mild 50% Moderate 15% Heavy 25% |
|
Ivanovich, 1983 [8] |
Low risk patients (9) |
H-HD 12 Prophylactic use of 200 ml
saline flushes every 20 minutes |
Saline |
HD circuit clotting Visual appearance post HD |
Occasional fiber clotting |
|
Casati, 1984 [10] |
High risk patients (29) |
H-HD111 Prophylactic use of up to
300 ml saline flushes every 15 minutes H + HD |
Saline |
HD circuit clotting Visual appearance |
H-HD Change of dialyzer required
in 10% Drip chamber clotting in
18% H + HD none |
|
Agresti, 1985 [3] |
High risk patients (6) |
H-HD 6 Prophylactic use of 200 ml
saline flushes every 30 minutes No controls |
Heparin 2000 units and saline |
Post-HD FBV |
1/6 treatments > 75% FBV clotting |
|
Sanders, 1985 [4] |
High risk patients (28) |
H-HD 156 No controls |
Heparin 3000 units and
saline |
HD circuit clotting Visual appearance |
H-HD Partial clotting 5.8% Complete clotting
requiring change of circuit5.1% |
|
Caruna, 1987 [11] |
Low risk Patients (8) |
H-HD 8 H-HD 8 ( 200 ml saline bolus
every 30 minutes) H-HD 8 (constant infusion of
saline 400 ml/hr) H + HD 8 (4000-5000 ml total heparin) |
Heparin 500 units and
saline |
HD circuit clotting % fiber loss |
H-HD (5% fiber loss, 0 clotting H-HD saline bolus (10%
fiber loss, 1 partial clotting) H-HD saline infusion (20% fiber loss, 2 partial
clotting) H + HD (3% fiber loss, 0
clotting) |
|
Caruna, 1987 [11] |
High risk Patients (29) |
H-HD 100 No controls |
Heparin 500 units and
saline |
HD circuit clotting Visual appearance |
H-HD Partial20% Complete7% |
|
Preuschof,1988 [5] |
High risk Patients (46) |
H-HD ( 250 ml saline bolus
every 15 minutes) H-HD (constant infusion of
saline 2000 ml/hr) H-HD (250 ml saline bolus every
15 minutes and constant infusion of
saline 2000 ml/hr) |
Saline Prophylactic change of the
HD circuit |
HD circuit clotting Visual appearance |
H-HD Prophylactic change of the
HD circuit due to impending clotting of the dialyzer*, 52% Partial5% Complete 3% |
|
Barth, 1989 [12] |
High risk Low risk |
H-HD 283 H + HD 1945 |
Heparin 2000 units and
saline |
HD circuit clotting Necessitating change of HD
circuit or early termination of HD |
H-HD PAN 1.3% RC 29% CA 26% H + HD PAN 0.5% RC 3% CA 11% |
|
Schwab, 1989 [6] |
High risk patients (49) |
H-HD 262 No controls |
Heparin 3000 units and
saline |
HD circuit Elevated venous pressures
unresponsive to saline flushes |
H-HD Partial clotting requiring
conversion to low dose heparin 7% Complete clotting
requiring interrupted HD 2% |
|
Romao, 1997 [13] |
Low risk patients (10) |
H-HD 10 H + HD 10 |
Saline Heparin + saline |
Fibrin deposition on
dialyzer |
Greater in H-HD P < 0.001 |
|
Stamatiadis, 2004 [7] |
High risk patients |
H-HD 16,954 (saline flushing 50 ml/hr) No controls |
Heparin 5000 units and saline |
HD circuit clotting Necessitating change of
circuit or termination of HD |
H-HD Complete 5% |
|
McGill, 2005 [14] |
High and low risk patients (90) |
H-HD (200 ml saline bolus every
15 minutes) H + HD (heparin bolus between
500-1500 units and heparin maintenance infusion 200-1000 units/hour) |
Saline |
HD circuit clotting Thrombosis of the dialyzer |
H-HD 5% H + HD 0% |
|
Liang, 2015 (present study) |
High and low risk patients (332) |
H-HD (no routine saline flush) H + HD (heparin bolus between
500-2000 units and heparin infusion 500 units/hour) |
Saline Heparin + saline |
HD circuit clotting Partial clotting in HD:
Intervention/flush required Partial clotting post HD:
Visual appearance Complete clotting:
necessitating change of circuit or termination of HD |
Partial clotting in HD: H-HD 12% H + HD 5.1% P = 0.025 Partial clotting post HD H-HD 20.9% H + HD 42.3% P < 0.001 Complete clotting: H-HD 9.1% H + HD 2.4% P = 0.008 |
RC:
Regenerated cellulose dialyzer, CA: Cellulose acetate dialyzer, PAN:
Polyacrylonitrile, FBV: Fiber bundle volume