The Problem of Anticoagulation During Hemodialysis and Hemodiafiltration Procedures in High Risk Patients with Acute Renal Failure

Abstract

The aim of this study was to compare two regimes of anticoagulatioti during hemodialysis and hemodiafiltration procedur es in patients with acute renal failure and bleeding diathesis. Changes of activated coagulation time (ACT) were investigated to estimate the significance of this test for bleedings and dialyser clotting predictions. 36 patients were divided into two groups. In the first group of 28 patients, anticoagulation for hemodialysis was achieved with heparin given as a bolus of 1000-1500 units at the beginning of the procedure. The regime of maintaining hepariniza-tion depended on hourly changes of ACT. If ACT measured 170 seconds or less, heparin boluses of 900 unit were repeated. In the second group dialysis was performed without heparin. This protocol was the most effective for the bleeding patients. The monitoring of ACT proved to be very useful in predicting dialyser clotting. The risk of dialyser clotting was especially high when cuprophan membranes were used.