Nephrology Dialysis Transplantation, Vol 12, Issue 1 106-110, Copyright © 1997 by Oxford University Press
J Romao, M Fadil, E Sabbaga and M Marcondes
Background. Haemodialysis without anticoagulant is an
alternative to systemic anticoagulation of patients at high risk of
bleeding. However, reports have suggested that heparin-free haemodialysis
might results in blood defibrination, and fibrin deposition in dialytic
membrane with possible reduction in dialyser efficiency.
Methods. Haemostasis parameters, fibrin-fibrinogen
kinetic assessed by 125-fibrinogen
(125I-F) turnover and
125I-fibrinogen deposition within the dialyser
membranes, and dialytic efficiency were studied in 10 stable chronic
uraemic patients. Each patient was dialysed on two consecutive 4-h
dialyses, once with each of two dialysis strategies: haemodialysis without
anticoagulant and conventional haemodialysis using heparin as
anticoagulant. Results. No significant changes were
seen in mean platelet count, plasma fibrinogen, prothrombin time, and
antithrombin II during haemodialysis without anticoagulation, and these
parameters were not different from those in patients who underwent
conventional haemodialysis. Compared with the predialysis values, a
shortening of the mean aPTT from an initial mean value was noted (P
<0.05) in haemodialysis without anticoagulation at 60, 120 and 240
min. Fibrin-fibrinogen degradation products remained unchanged during
conventional haemodialysis, but were increased after the 30th minute of
haemodialysis without anticoagulation (P <0.05), although all values
were in normal range. The biological half-life of
125I-F in uraemic patients before the haemodialysis
was 5.02±0.43 days (control). There was a significant fall in
125I-F half-life during haemodialysis without
anticoagulation (2.56±0.58 days; P <0.01) but not during
conventional haemodialysis (4.77 ±0.97, NS). After use each
dialyser was dismantled and 125I-F deposition within
the membranes (M#5, M#12 and M#19) was measured.
During haemodialysis without anticoagulation mean fibrin deposition in
M#5 (28.74±10.50x103 counts),
M#12 (26.42±9.06x103 counts), and
M#19 (21.97±8.33x103 counts) was
greater (P <0.001) than that during conventional haemodialysis
(1.70±0.92x103,
1.33±0.65x103, and
1.59±1.03x103 counts respectively).
However, this greater deposition of fibrin on membranes during
haemodialysis without anticoagulation did not change dialyser efficiency as
assessed (haemodialysis without anticoagulation vs conventional
haemodialysis) by change in serum urea (- 53.96 ± 3.38% vs
-51.96 ± 5.20%, NS), serum creatinine (-48.65 ± 5.99%
vs -49.59 ± 6.65%, NS), serum potassium (-30.06 ±
4.46% vs -27.64 ± 2.81%, NS), serum bicarbonate (+3.20
± 3.99% vs 2.15 ± 2.01%, NS) and haematocrit (+3.20
± 3.99% vs 2.15 ± 2.01%, NS) The mean Kt/V was
similar for conventional haemodialysis (0.870 ± 0.107).
Conclusion. In conclusion, although conventional
haemostasis parameters remained unchanged during haemodialysis without
anticoagulation, some degree of activation coagulation system occurs,
haemodialysis without anticoagulation was associated with greater decline
in 125I-F half-life and greater fibrin deposition on
dialyser membranes, but with no change in dialyser efficiency.
Key words: fibrinogen; haemodialysis; anticoagulation;
fibrinolysis
ORIGINAL ARTICLES
Haemodialysis without anticoagulant: haemostasis parameters, fibrinogen kinetic, and dialysis efficiency
Nephrology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Av. Sr Eneas C. Aguiar, 255 Sala 713E, 05403-000, Sao Paulo, Brazil
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