Key result
Heparin-albumin priming cuts heparin exposure ~76% without increasing circuit clotting vs standard care.
Why the study?
Intermittent hemodialysis in patients at increased bleeding risk requires modified anticoagulation strategies to limit heparin exposure and avoid clotting of the extracorporeal circuit.
Does priming the extracorporeal circuit with a heparin and albumin mixture reduce systemic heparin exposure without increasing clotting in hemodialysis patients at risk for bleeding?
Cohort (n=321)
Does priming the extracorporeal circuit with a heparin and albumin mixture reduce systemic heparin exposure without increasing clotting in hemodialysis patients at risk for bleeding?
Priming the extracorporeal circuit with a heparin and albumin mixture reduces systemic heparin exposure without increasing clotting risk in hemodialysis patients at high bleeding risk.
May support reduced heparin exposure via albumin priming in bleeding-risk hemodialysis; hypothesis-generating, requires randomized confirmation.
INTRODUCTION: Intermittent hemodialysis (IHD) is sometimes necessary in patients with a bleeding risk, i.e., before/after surgery or brain hemorrhage. In such case IHD has to be modified to limit the conventional anticoagulation used to avoid clotting of the extracorporeal circuit (ECC). We evaluated if priming using a heparin and albumin (HA) mixture could minimize the exposure to heparin. METHODS: Retrospective data from 1995 to 2013 were collected from 1408 acute dialysis treatment protocols that included 321 patients. Comparisons were made between IHD patients that had increased risk for bleeding and were treated by standard anticoagulation (Group-S), and patients at increased risk of bleeding (Group-HA). The ECC in Group-HA was primed with a solution of unfractioned heparin (UFH) (5000 Units/L) and albumin (1 g/L) in saline that was discarded after priming. There were 16 different dialyzers in the material. FINDINGS: Comparing Group-S (n = 883) with Group-HA (n = 221), the mean age was 61.6 vs. 62.2 years (P = 0.8), dialysis time was 197 vs. 190 minutes (P = 0.002), and total dose of intravenous anticoagulant/IHD was at median 5000 Units vs. 1200 Units (P = 0.001). Twenty-four percent of patients were treated without any additional heparin. Clotting resulting in interrupted dialysis was similar in both groups (0.8% for Group-S vs. 1.0% for Group-HA, P = 0.8). No secondary bleeding was reported in either group. DISCUSSION: HA priming minimized the risk of clotting and enabled acute IHD in vulnerable patients without increased bleeding, thus allowing completion of IHD to the same extent as for standard HD.
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Skagerlind et al. (2016) conducted a cohort in Hemodialysis patients at risk for bleeding (n=321). Heparin and albumin (HA) priming vs. Standard anticoagulation was evaluated on Clotting resulting in interrupted dialysis (p=0.8). Heparin and albumin priming reduced heparin exposure (1200 vs 5000 Units, P=0.001) with similar rates of interrupted dialysis due to clotting compared to standard care (1.0% vs 0.8%, P=0.8).
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