Prospective Study of Routine Heparin Avoidance Hemodialysis in a Tertiary Acute Care Inpatient Practice

Sami Safadi, Robert C. Albright, John J. Dillon, Amy W. Williams, Fares Alahdab, Julie K. Brown, Amanda L. Severson, Walter K Kremers, Mary Ann Ryan, Marie C Hogan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction Extracorporeal circuit (EC) anticoagulation with heparin is a key advance in hemodialysis (HD), but anticoagulation is problematic in inpatients at risk of bleeding. We prospectively evaluated a heparin-avoidance HD protocol, clotting of the EC circuit (CEC), impact on dialysis efficiency, and associated risk factors in our acute care inpatients who required HD (January 17, 2014 to May 31, 2015). Methods HD sessions without routine EC heparin were performed using airless dialysis tubing. Patients received systemic anticoagulation therapy and/or antiplatelets for non-HD indications. We observed patients for indications of CEC (interrupted HD session, circuit loss, or inability to return blood). The primary outcome was CEC. Logistic regression with generalized estimating equations assessed associations between CEC and other variables. Results HD sessions (n = 1200) were performed in 338 patients (204 with end-stage renal disease; 134 with acute kidney injury); a median session was 211 minutes (interquartile range [IQR]: 183−240 minutes); delivered dialysis dose measured by Kt/V was 1.4 (IQR: 1.2 Kt/V 1.7). Heparin in the EC was prescribed in only 4.5% of sessions; EC clotting rate was 5.2%. Determinants for CEC were temporary catheters (odds ratio [OR]: 2.8; P < 0.01), transfusions (OR: 2.4; P = 0.04), therapeutic systemic anticoagulation (OR: 0.2; P < 0.01), and antiplatelets (OR: 0.4; P < 0.01). CEC was associated with a lower delivered Kt/V (difference: 0.39; P < 0.01). Most CEC events during transfusions (71%) occurred with administration of blood products through the HD circuit. Discussion We successfully adopted heparin avoidance using airless HD tubing as our standard inpatient protocol. This protocol is feasible and safe in acute care inpatient HD. CEC rates were low and were associated with temporary HD catheters and transfusions. Antiplatelet agents and systemic anticoagulation were protective. ClinicalTrials.gov Identifier:NCT02086682.

Original languageEnglish (US)
Pages (from-to)695-704
Number of pages10
JournalJournal of Computational Design and Engineering
Volume4
Issue number3
DOIs
StatePublished - Jul 1 2017

Fingerprint

Heparin
Acute
Networks (circuits)
Odds Ratio
Dialysis
Interquartile range
Catheters
Tubing
Blood
Generalized Estimating Equations
Kidney
Risk Factors
Logistic Regression

Keywords

  • acute kidney injury
  • anticoagulation
  • extracorporeal circulation
  • hemodialysis
  • no heparin

ASJC Scopus subject areas

  • Computer Graphics and Computer-Aided Design
  • Human-Computer Interaction
  • Engineering (miscellaneous)
  • Computational Mechanics
  • Computational Mathematics
  • Modeling and Simulation

Cite this

Prospective Study of Routine Heparin Avoidance Hemodialysis in a Tertiary Acute Care Inpatient Practice. / Safadi, Sami; Albright, Robert C.; Dillon, John J.; Williams, Amy W.; Alahdab, Fares; Brown, Julie K.; Severson, Amanda L.; Kremers, Walter K; Ryan, Mary Ann; Hogan, Marie C.

In: Journal of Computational Design and Engineering, Vol. 4, No. 3, 01.07.2017, p. 695-704.

Research output: Contribution to journalArticle

Safadi, Sami ; Albright, Robert C. ; Dillon, John J. ; Williams, Amy W. ; Alahdab, Fares ; Brown, Julie K. ; Severson, Amanda L. ; Kremers, Walter K ; Ryan, Mary Ann ; Hogan, Marie C. / Prospective Study of Routine Heparin Avoidance Hemodialysis in a Tertiary Acute Care Inpatient Practice. In: Journal of Computational Design and Engineering. 2017 ; Vol. 4, No. 3. pp. 695-704.
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author = "Sami Safadi and Albright, {Robert C.} and Dillon, {John J.} and Williams, {Amy W.} and Fares Alahdab and Brown, {Julie K.} and Severson, {Amanda L.} and Kremers, {Walter K} and Ryan, {Mary Ann} and Hogan, {Marie C}",
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AU - Dillon, John J.

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AU - Alahdab, Fares

AU - Brown, Julie K.

AU - Severson, Amanda L.

AU - Kremers, Walter K

AU - Ryan, Mary Ann

AU - Hogan, Marie C

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N2 - Introduction Extracorporeal circuit (EC) anticoagulation with heparin is a key advance in hemodialysis (HD), but anticoagulation is problematic in inpatients at risk of bleeding. We prospectively evaluated a heparin-avoidance HD protocol, clotting of the EC circuit (CEC), impact on dialysis efficiency, and associated risk factors in our acute care inpatients who required HD (January 17, 2014 to May 31, 2015). Methods HD sessions without routine EC heparin were performed using airless dialysis tubing. Patients received systemic anticoagulation therapy and/or antiplatelets for non-HD indications. We observed patients for indications of CEC (interrupted HD session, circuit loss, or inability to return blood). The primary outcome was CEC. Logistic regression with generalized estimating equations assessed associations between CEC and other variables. Results HD sessions (n = 1200) were performed in 338 patients (204 with end-stage renal disease; 134 with acute kidney injury); a median session was 211 minutes (interquartile range [IQR]: 183−240 minutes); delivered dialysis dose measured by Kt/V was 1.4 (IQR: 1.2 Kt/V 1.7). Heparin in the EC was prescribed in only 4.5% of sessions; EC clotting rate was 5.2%. Determinants for CEC were temporary catheters (odds ratio [OR]: 2.8; P < 0.01), transfusions (OR: 2.4; P = 0.04), therapeutic systemic anticoagulation (OR: 0.2; P < 0.01), and antiplatelets (OR: 0.4; P < 0.01). CEC was associated with a lower delivered Kt/V (difference: 0.39; P < 0.01). Most CEC events during transfusions (71%) occurred with administration of blood products through the HD circuit. Discussion We successfully adopted heparin avoidance using airless HD tubing as our standard inpatient protocol. This protocol is feasible and safe in acute care inpatient HD. CEC rates were low and were associated with temporary HD catheters and transfusions. Antiplatelet agents and systemic anticoagulation were protective. ClinicalTrials.gov Identifier:NCT02086682.

AB - Introduction Extracorporeal circuit (EC) anticoagulation with heparin is a key advance in hemodialysis (HD), but anticoagulation is problematic in inpatients at risk of bleeding. We prospectively evaluated a heparin-avoidance HD protocol, clotting of the EC circuit (CEC), impact on dialysis efficiency, and associated risk factors in our acute care inpatients who required HD (January 17, 2014 to May 31, 2015). Methods HD sessions without routine EC heparin were performed using airless dialysis tubing. Patients received systemic anticoagulation therapy and/or antiplatelets for non-HD indications. We observed patients for indications of CEC (interrupted HD session, circuit loss, or inability to return blood). The primary outcome was CEC. Logistic regression with generalized estimating equations assessed associations between CEC and other variables. Results HD sessions (n = 1200) were performed in 338 patients (204 with end-stage renal disease; 134 with acute kidney injury); a median session was 211 minutes (interquartile range [IQR]: 183−240 minutes); delivered dialysis dose measured by Kt/V was 1.4 (IQR: 1.2 Kt/V 1.7). Heparin in the EC was prescribed in only 4.5% of sessions; EC clotting rate was 5.2%. Determinants for CEC were temporary catheters (odds ratio [OR]: 2.8; P < 0.01), transfusions (OR: 2.4; P = 0.04), therapeutic systemic anticoagulation (OR: 0.2; P < 0.01), and antiplatelets (OR: 0.4; P < 0.01). CEC was associated with a lower delivered Kt/V (difference: 0.39; P < 0.01). Most CEC events during transfusions (71%) occurred with administration of blood products through the HD circuit. Discussion We successfully adopted heparin avoidance using airless HD tubing as our standard inpatient protocol. This protocol is feasible and safe in acute care inpatient HD. CEC rates were low and were associated with temporary HD catheters and transfusions. Antiplatelet agents and systemic anticoagulation were protective. ClinicalTrials.gov Identifier:NCT02086682.

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