Heparin-free hemodialysis

Hemodialysis is the most widely applied renal replacement therapy. Due to the fact that the hemocyte - dialyzer contact leads to the activation of the coagulation pathway, adequate anticoagulation to provide fluent blood flow is crucial. Since the standard parenteral use of heparin is not free from complications and may increase already raised bleeding risk in renal patients, the alternative methods of performing hemodialysis, including heparin-free procedures, are being investigated. These include the usage of anticoagulants regionally in the extracorporeal circuit or repeated saline flushes or other substituting compounds. Citrate module has already become the standard anticoagulant in intensive care for patients on continuous hemofiltration. Its usage in intermittent dialysis program requires some protocol modifications, but it is a valuable input in the development of heparin-free strategies. The other approach that allows reduced heparin usage is the use of an airless dialysis tubing system. Amongst coated dialyzer membranes, the one with heparinized hydrogel polyacrylonitrile was perceived as a significant step forward. Despite the fact that innovative strategies may turn out to be time and resource consuming and not always free of side-effects, they are worth investigating.