title: Rinsing the extra corporeal circuit with a heparin and albumin solution reduces the need for systemic anticoagulant in hemodialysis.
abstract: BACKGROUND
  Systemic anticoagulation during hemodialysis (HD) increases the risk for bleeding complications pre- or post-operatively. Based on the concept of blood-membrane interaction, we developed a heparin-albumin solution to rinse the dialysis circuit before start. The aim of this study was to investigate if this method was a valuable tool for our patients at risk for bleeding complications.
  
  
  METHODS
  This retrospective, comparative, quality assessment study included 248 HD in 68 patients; Group1: 178 treatments were performed at patients for risk of bleeding using heparin-albumin-priming and Group 2: 70 acute HD were performed on patients without increased risk of bleeding using a bolus of heparin at start and a continuous infusion of heparin. In Group 1 additional heparin was given upon suspicion of progressive clotting. One L saline contained albumin (1 g/l) and heparin (5000 U/l) used for priming. Excess priming solution was removed by filling the circuit with blood at start of treatment.
  
  
  RESULTS
  In Group 1, a mean total dose of 2000 U of heparin was given during the HD (18% performed HD without any heparin) and Group 2 used a mean total dose of 5500 U (p<0.001). There was no increased incidence of clotting in Group 1 versus Group 2 compared to standard HD. No bleeding complications were reported during any of the HA-priming treatments.
  
  
  CONCLUSIONS
  Heparin-albumin priming resulted in a reduced total dose of heparin. There was no increased clotting and no incidence of bleeding was reported in either group.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå - Sweden.
authors.forename: Filip
authors.initials: F
authors.lastname: Fransson
authors.forename: Tobias
authors.initials: T
authors.lastname: Kyrk
authors.forename: Malin
authors.initials: M
authors.lastname: Skagerlind
authors.forename: Bernd
authors.initials: B
authors.lastname: Stegmayr
mesh_terms: D000328:Adult; D000418:Albumins / Q000008:administration & dosage / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D000925:Anticoagulants; D006493:Heparin