Association between Anticoagulation Strategy and Quality of Life in Chronic Hemodialysis Patients

Prevention of clotting in hemodialysis (HD) is a concern, but tools to monitor anticoagulation strategies as well as data on bleeding and its impact on quality of life (QoL) are scant. In this prospective longitudinal observational study, bleeding tendency in 70 HD patients was scored with ISTH-BAT and HAS-BLED at week 0, 4, and 8. Patient’s limbs were visually scored for bruises and hematomas, and Quality of Life (QoL) was assessed using EQ5D-3L and Visual Analogue Scale (VAS) questionnaires. At week 0, the used hemodialyzer was scanned in a micro-CT scanner to quantify the number of patent fibers. Bleeding scores were 0[0;1] and 3[2;4] for ISTH-BAT and HAS-BLED, and visual scoring showed 2[0;4] bruises/hematomas. QoL was 0.85[0.77;1.00] for EQ5D and 70[60;80] for VAS. Fiber patency was 81[70;90]%, but was not associated with anticoagulation dose (p = 0.103). Patients in the highest tertile of anticoagulation dose had a worse VAS score (p = 0.027), and patients identified as having bleeding tendency by ISTH also had a worse VAS score (p = 0.010). Thus, in maintenance HD patients, dialyzer fiber blocking is rather limited, but the substantial degree of minor bleeding suggests that current anticoagulation doses are potentially too exaggerated, negatively impacting QoL.