Epidemiology Of Anticoagulation And Appropriate Dosage Of Anticoagulant Treatment In Hemodialysis Patient

Background and objective:Hemodialysis (HD) is the main treatment for patients with end-stage renal disease, while an appropriate anticoagulation is an important component of HD. Effective anticoagulant can guarantee the implementation of hemodialysis, reduce the blood in vitro artificial line contact as a result of inflammation and improve biocompatibility. However, there's few standardized anticoagulation regimen in HD has been issued in our country untill now. The primary cause is lack of clinical research. In the foundation of an epidemiologic survey be hold in 7 hemodalysis centers, the present study is to investigate the appropriate dose of unfraction heparin and low molecular weight heparin (LMWH) in hemodialysis patients and accumulate clinical research material evidences for the efficacy and safety of anticoagulant treatment in China.Methods:1. A questionnaire survey was conducted in 7 hemodialysis centers on the hemodialysis status, primary diseases, anticoagulation methods, and complications.2. Thirty-eight hemodialysis patients were enrolled and randomly allocated into four groups:(1) Low-dose UFH group (LH group); (2)Low-dose UFH+ re-flushing group (LUFH group); (3) High-dose UFH group (HH group); (4) Low-dose LMWH group (LLMWH group); (5) Low dose of LMWH+ pre-flushing group (LLMWUFH group); (6) High-dose LMWH group (HLMWH group). Before hemodialysis, glass bead active clotting time (gbACT), clot rate (CR) and platelet function (PF) were examined using Sonoclot analysator at Oh, 2h and the end of hemodialysis at the arterial circuit and 2h at the venous circuit, Results:1. Among 842 patients,808 (95.9%) cases were treated with HD, and the other 34 (4.1%) cases with hemodialysis filtration (HDF). In the HD treatment group,606 patients (72.0%) used heparin as the anticoagulant agent, in which 449 cases with heparinized saline priming. Difference in the initial dose and repeated maintenance dose were significant among the centers.223 patients (26.5%) used low molecular heparin and the kinds and dosages of which among the hemodialysis centers were different. The percentage of diabetes, hypertension and other diseases were 127 (15.1%),79(9.4%) and 636(75.5%), respectively. No difference in the dosage of heparin were found among different diseases, while the dosage of low molecular heparin in diabetes and hypertension were lower. Patients with hemorrhagic tendency accounted for 162(19.2%), patients with thrombus accounted for 63 (7.5%). The dosage of heparin were lower in patients with hemorrhagic patients while no difference were found in the dosages of low molecular heparin. Antiplatelet agents were coadministrated in 172 (20.4%) HD patients. The percentage of coadministration of antiplatelet for patients with thrombus and hemorrhagic tendency were 32% and 11.1%, respectively. The dosage of heparin and low molecular heparin was higher in patients with coadministration than patients without coadministration. Coagulation tests were measured in 385 (45.7%) patients, no difference in the frequency were found among the patients with hemorrhagic tendency, thrombus and others.2. All HD complete successfully. (1) LH and LUFH:the increase of gbACT and decrease of CR at the arterial circuit and the venous circuit at 2h of hemodialysis were significant compared with baseline of CR at the arterial circuit and the venous circuit at 2h of hemodialysis were significant compared with baseline while the recovered at the end of hemodialysis. No difference between the two groups at different time points was found, either. (2) LLMWH:No change were found in gbACT during hemodialysis. CR at the arterial circuit and the venous circuit were significantly decreased at 2h and recovered at the end of hemodialysis. (3) LLMWHUFH:gbACT at the arterial circuit was significantly increased only at 2h of hemodialysis. CR at the arterial circuit and the venous circuit at 2h of hemodialysis were significantly increased and recovered when hemodialysis finished. (4) HH and HLMWH:gbACT were significantly increased and CR were rapidly decreased at both the arterial circuit and the venous circuit at 2h of hemodialysis.Conclustions:1. Heparin is the main anticoagulant in hemodialysis. The anticoagulant methods in hemodialyis is empirical which is absent of clotting monitor and standard.2. Low-dose heparin was effective and safe as anticoagulant in hemodialysis. Low-dose LMWH was efficient in anticoagulation to some extent. However, high-dose LMWH, high-dose heparin and flushing with heparinized saline may increase the risk of hemorrhage.