Anticoagulation treatments related different types of vascular access on maintenance hemodialysis patient: A multicenter epidemiological investigation

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Objective: The objective was to increase the understanding of vascular access in hemodialysis and evaluate hemodialysis-related anticoagulation treatments and the associated hemorrhagic or thrombotic complications. Materials and Methods: In this study, an epidemiological investigation was conducted in 1175 patients who underwent hemodialysis in seven blood purification centers in northern Chinese. The patients were divided into two groups based on the vascular access they used: Arteriovenous fistula (AVF) group and central venous catheter (CVC) group. The similarities and differences of anticoagulation and hemorrhagic, thrombotic complications were compared between two groups. Results: Arteriovenous fistula was the most frequently used vascular access, and heparin was the most commonly used anticoagulant. Patients in CVC group experienced significantly greater rates of low molecular weight heparin (LMWH) administration and had a higher rate in achieving thrombotic complications than those in AVF group. There were no significant differences in LMWH dosages in patients with thrombotic complications, as well as the proportion of patients who received anti-platelet drugs. Heparinized catheter lock solutions were excessively high in this study, which may lead to a risk of hemorrhage. Conclusion: Hemodialysis-related anticoagulation treatments in China require additional improvements, especially for the patients using CVC as vascular access. There is an urgent need to develop clinical evaluation studies of anticoagulation treatments for achieving more standardized and targeted treatments.

1. MacRae JM, Ahmed A, Johnson N, Levin A, Kiaii M. Central vein stenosis: A common problem in patients on hemodialysis. ASAIO J 2005;51:77-81.

2. III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: Update 2000. Am J Kidney Dis 2001;37 1 (Suppl 1):S137-81.

3. Sun XF, Xiao Q, Wang Y, Hao LR, Lin HL, Zhang ZM, et al. Epidemiology of anticoagulation for hemodialysis patients: Survey of 842 cases in seven hemodialysis centers. Zhonghua Yi Xue Za Zhi 2009;89:577-81.

4. Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, et al. Vascular access use in Europe and the United States: Results from the DOPPS. Kidney Int 2002;61:305-16.

5. National Kidney Foundation. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for 2006 updates: Hemodialysis Adequacy, Peritoneal Dialysis adequacy and vascular access. Am J Kidney Dis 2006;48:s1-322.

6. Pieters P. Venous Catheters. New York: Thieme Medical Publishers; 2003.

7. Dwyer A. Surface-treated catheters — A review. Semin Dial 2008;21:542-6.

8. Oliver MJ, Mendelssohn DC, Quinn RR, Richardson EP, Rajan DK, Pugash RA, et al. Catheter patency and function after catheter sheath disruption: A pilot study. Clin J Am Soc Nephrol 2007;2:1201-6.

9. Yevzlin AS. Hemodialysis catheter-associated central venous stenosis. Semin Dial 2008;21:522-7.

10. Antón-Pérez G, Pérez-Borges P, Alonso-Almán F, Vega-Díaz N. Vascular accesses in haemodialysis: A challenge to be met. Nefrologia 2012;32:103-7.

11. Chen YP. Cardiovascular disease caused by chronic kidney disease. Chin J Pract Intern Med 2010;30:108-10.

12. Wang GQ, Chen YP. Antithrombotic therapy for coronary heart disease in patients with chronic renal insufficiency. Chin J Pract Intern Med 2011;31:333-5.

13. Kerr P, Perkovic V, Petrie J, Agar J, Disney A, Caring for Australians with Renal Impairment (CARI). The CARI guidelines. Dialysis adequacy (HD) guidelines. Nephrology (Carlton) 2005;10 (Suppl 4):S61-80.

14. Suranyi M, Chow JS. Review: Anticoagulation for haemodialysis. Nephrology (Carlton) 2010;15:386-92.

15. Stevens KN, Croes S, Boersma RS, Stobberingh EE, van der Marel C, van der Veen FH, et al. Hydrophilic surface coatings with embedded biocidal silver nanoparticles and sodium heparin for central venous catheters. Biomaterials 2011;32:1264-9.

16. Saran R, Dykstra DM, Wolfe RA, Gillespie B, Held PJ, Young EW, et al. Association between vascular access failure and the use of specific drugs: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2002;40:1255-63.

17. Dempster DW, Rosenstock JL, Schwimmer JA, Panagopoulos G, DeVita MV, Michelis MF. Underutilization of aspirin in hemodialysis patients for primary and secondary prevention of cardiovascular disease. Clin Nephrol 2005;64:371-7.

18. US-DOPPS Practice Monitor; April, 2013. Available from: [Last accessed on 2014 Apr 2].

19. Agharazii M, Plamondon I, Lebel M, Douville P, Desmeules S. Estimation of heparin leak into the systemic circulation after central venous catheter heparin lock. Nephrol Dial Transplant 2005;20:1238-40.

20. Thomson PC, Morris ST, Mactier RA. The effect of heparinized catheter lock solutions on systemic anticoagulation in hemodialysis patients. Clin Nephrol 2011;75:212-7.