FP548CONTINUOUS SALINE INFUSION VERSUS INTERMITTENT SALINE FLUSHING IN PREVENTING CLOT FORMATION DURING HEPARIN-FREE HEMODIALYSIS

INTRODUCTION: Heparin-free hemodialysis (HD) is a challenging procedure as it increases the risk of clotting in the extracorporeal circuit (ECC) which may lead to significant blood loss causing anemia that may require blood transfusions, increasing doses of erythropoiesis-stimulating agents (ESAs) and iron supplements, thus adding to the burden of treatment cost. Although intermittent saline flushing (ISF) is a widely adopted method for the prevention of clotting during heparin-free hemodialysis, it is still sensible to find better techniques which can improve patient outcomes. The purpose of this study is to compare the effectiveness of ISF versus continuous saline infusion (CSI) in preventing clot formation in the ECC during heparin-free hemodialysis. METHODS: We included 34 eligible heparin-free hemodialysis patients in the final analysis of this open-label randomized controlled trial accounting for a total of 102 HD treatments. In the ISF group (N=17), 100 ml of 0.9% NaCl was flushed every 15 minutes while in the CSI group (N=17), infusion of 0.9% NaCl at a rate of 200 ml/hour via infusion pump was done over the entire length of the HD session. The observation was done for three consecutive HD sessions starting from the first use of dialyzer. The evaluation of severity of clotting of ECCs was performed in both groups at the end of every dialysis session by the nurse in charge and the head nurse using a visual clotting scale. RESULTS: The baseline characteristics of the patients in both groups were not statistically different indicating a homogenous population. All the 102 dialysis treatments were considered successful since there was no complete occlusion of air traps or dialyzer rendering dialysis impossible, no additional saline flushes to prevent clotting were used, no change of dialyzer or blood lines because of clotting, and no premature termination of HD because of clotting. However, there was a statistically significant difference (<0.001) in the grading of the ECCs between the two groups from the first to the third use of dialyzers. Patients in the CSI group had absent or minimal clot formation (Grade 1 and 2) at the end of their dialysis sessions according to the visual clotting scale. In contrast, there were more clot formation (Grade 2 and 3) in the ISF group in all dialysis treatments especially in the 2nd and 3rd use of dialyzer. CONCLUSIONS: In patients undergoing heparin-free hemodialysis, CSI may be a better method to prevent clot formation in the ECC than the conventional ISF. This may have the advantage of preventing additional treatment expenses from blood transfusions, increasing doses of ESAs and iron supplements, and changing of tubings and dialyzers due to clot formation. CSI may also provide more efficient dialysis treatment by preventing intradialytic interruptions and premature dialysis termination.