Avoiding Systemic Heparinization During Hemodialysis: How the Dialysis Setup Might Help

Heparin is the most widely used anticoagulant for maintaining patency of the extracorporeal blood circuit during intermittent hemodialysis. Inadvertently, this leads to systemic heparinization of the patient. Repeated intermittent heparinization during hemodialysis has been associated with increased...

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Bibliographic Details
Published in:	Seminars in nephrology Vol. 43; no. 6; p. 151483
Main Authors:	Janssens, Florine V., Meijers, Björn, François, Karlien
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-11-2023
Subjects:	Anticoagulation clotting extracorporeal circuit heparin-free hemodialysis kidney failure kidney failure Anticoagulation extracorporeal circuit clotting heparin-free hemodialysis
Online Access:	Get full text
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Summary:	Heparin is the most widely used anticoagulant for maintaining patency of the extracorporeal blood circuit during intermittent hemodialysis. Inadvertently, this leads to systemic heparinization of the patient. Repeated intermittent heparinization during hemodialysis has been associated with increased bleeding risks and metabolic and immunologic effects. Alternative strategies for minimizing systemic anticoagulation encompass dilution methods, regional citrate anticoagulation, priming of the extracorporeal circuit, and modifications to dialyzer membranes and dialysate composition. The effectiveness of these alternatives in maintaining patency of the extracorporeal circuit varies substantially. Although most studies have focused on particular changes in the hemodialysis setup, several combined interventions for adapting the hemodialysis setup are now being studied. This narrative review aims to present an overview of the current landscape of hemodialysis setup strategies aimed at limiting or avoiding systemic anticoagulation during treatment. Additionally, this review intends to shed light on the underlying pathophysiological mechanisms that contribute to variations observed in reported outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	0270-9295 1558-4488 1558-4488
DOI:	10.1016/j.semnephrol.2023.151483