Abstract: SA-PO446
Recurrent Clotting of the Filter in Home Hemodialysis With NxStage System One: A Case Report
Session Information
- Hemodialysis and Frequent Dialysis: Clearance, Technology, Infection
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Dhayalan, Dhayanithi, Harbor-UCLA Medical Center, Torrance, California, United States
- Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
- Dai, Tiane, Harbor-UCLA Medical Center, Torrance, California, United States
Introduction
Clotting of the dialyzer is one complication in home hemodialysis. Recurrent filter clotting without pro-thrombotic factors is relatively uncommon. We report an adult male with recurrent clotting of the venous header of the filter in NxStage System One during home hemodialysis.
Case Description
A 60-year-old African American male with end stage renal disease from obstructive nephropathy due to prostate cancer was in remission after radiation therapy. He started on in-center hemodialysis via a tunneled internal jugular catheter. Two years later, he transitioned to home hemodialysis due to uncontrolled blood pressure and phosphorus levels. He was on apixaban for anticoagulation due to a history of paroxysmal atrial fibrillation. Patient did well on home hemodialysis via a right brachiocephalic fistula prior to his hospitalization for bladder bleeding that was attributed to radiation cystitis. Apixiban was temporarily discontinued. After discharge, patient started experiencing recurrent clotting of the venous header of the NxStage System One filter, which did not resolve with restarting Apixaban, changing the blood flow rate, increasing the heparin bolus dose, and adding a heparin infusion or saline flush hourly. He had no history of recurrent thrombosis of his vascular access nor identifiable pro-thrombotic risk factors. The clotting issue did not occur when he received in-center or in-hospital dialysis, where a standard (Fresenius) dialysis machine and high flux dialyzer were used. Clotting appeared to resolve with a combination of: 1) Flushing the dialyzer with at least one liter of saline; 2) Administration of apixaban 5mg one hour prior to dialysis; and 3) Using a higher heparin bolus dose 50units/kg (4,000units) with a supplemental 1,000 unit/hr infusion. The patient now experiences prolonged post-dialysis bleeding time and the AVF requires a careful pressure dressing.
Discussion
Dialyzer clotting during home hemodialysis is one of the complications. Recurrent clotting of the filter in the NxStage System One is uncommon but can occur in home hemodialysis patients with no identifiable pro-thrombotic factors. Clotting may be prevented by an increase in anticoagulant dosing. Higher bleeding risk is one of the precautions.