Журнал нефрологии и терапии

Pre Filter Hemodiafiltration with Heparin-Dose Minimization: A Safe and Effective Technique

Abstract

Sergio VO, Mónica SC, Evelyn CDR, Raúl I, Enzo VJ and Héctor PGG

Background: Unfractionated heparin (UFH) administered during hemodialysis (HD) has cumulative adverse effects; hence the importance of using the lowest possible dose and avoid overdosing. Methods: We analyzed 30 patients with chronic hemodiafiltración (HDF) treatment divided in 3 groups: pos filter HDF with heparin standard impregnation dose (27 ± 6.5 IU/kg), HDF pos filter with impregnation low dose (15 ± 4.2 IU/ kg); in both groups, heparin impregnation and maintenance were given, and a third group HDF pre-dilution only with heparin impregnation dose (27 ± 12.8 IU/kg). We measured partial thromboplastin time (aPTT) and serum heparin levels at 30 and 190 min, in the three groups. Results: HDF pre-dilution group received a significantly lower total dose than the other 2 groups; 1750 vs. 2650/3444 UI/Kg (p<0.001), maintaining 30 min aPTT target (55.6 ± 43.4) as aPTT 190 min (44.4 ± 30.3), as well as effectiveness of the treatment (substitution volume of 51.4 ± 11.8 L, Ktv 1.38 ± 0.3). The other two groups reached aPTT 30 min target, but decreased towards the end of HDF sessions (aPTT 190 min). HDF pre-dilution did not increase clot formation (p<0.678). There were no major coagulation or bleeding events in any of the HDF sessions. Conclusion: Pre dilution HDF with only impregnation heparin is a safe and effective method; after the amplification and reproduction of our results, it could represent an alternative treatment that minimizes UFH doses in order to reduce the associated adverse events.