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Abstract: FR-PO456

Safety and Efficiency of Low-Molecular-Weight Heparin (LMNH) Administered in the Venous Line of Patients Treated by Online Hemodiafiltration and High Flux Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hedia, Hebibi, NephroCare, Villejuif, France
  • Attaf, David, Fresenius, Fresnes, France
Background

Removal of low molecular weight heparin (LMWH) occurs during high flux hemodialysis (HF-HD) and online hemodiafiltration (OL-HDF) if administered before the dialysis session in the arterial line of the extracorporeal HD circuit . It is recommended to administer (LVMH) through the venous line to improve anti-coagulation efficacy. The goal of our study is to evaluate efficacy, and safety of LMWH administered through the venous line in OL-HDF and HF-HD patients

Methods

We enrolled 49 OL-HDF and 48 HF-HD patients from February to October 2018 (mean age 66 yrs.arteriovenous fistula 90%, the average dialysis time 240 min). Three consecutive 6-week periods (i.e. 5400 dialysis sessions) were analyzed according to the path and dose of (LMWH) administration: Phase I (arterial line), phase II (venous line), phase III (reduced dose). Phase I and II involved HF-HD + OL-HDF patients, and phase III involved only Ol-HDF patients. In each session we evaluated filter and chamber clotting (semi-quantitative visual scale), venous pressure, KT/V, volume infused in OL-HDF. The 3 periods were done with FX membranes (90%) , BK, BG

Results

34 %, 63 % and 66% of membranes were scored as “clean” during phases I, II, III respectively (p<0.05). 9%, 0.6% and 0.4 % of membranes clotted during phases I, II, III respectively. 75%, 93% et 95% of venous chambers were clean during phases I, II, III respectively (p<0.05). 1%, 0% , 0% were clotted with loss of circuit during phases I, II, III respectively (p<0.05). Average LMWH doses were: 0.43 ml (0.2-0.6) and 0.3 ml (0.2-0.6) of Nadroparin during phases I, II respectively (p<0,001). During phase III, LMWH dose decreased from 33 to 50% for 58% of patients with an anti-Xa target = 0.3ui/ml. Between phases I -III, KT/V improved from 1.71 to 1.83 (p<0.005), Infused volume from 20.7 to 23.7 l. Bleeding time was identical during Ph I - Ph III. In the HF-HD sub-group during phases I and II, venous LMWH administration decreased the average LMWH dose from 0.55 ml to 0.34 ml respectively and improved the quality of blood restitution.

Conclusion

Venous line administration of LMWH at the start of dialysis allows a dose reduction and improvement of dialysis adequacy parameters.