Avoiding Systemic Heparinization During Hemodialysis: How the Dialysis Setup Might Help.

IF 2.8 3区医学 Q2 UROLOGY & NEPHROLOGY

Seminars in nephrology Pub Date : 2023-11-01 Epub Date: 2024-01-13 DOI:10.1016/j.semnephrol.2023.151483

Florine V Janssens, Björn Meijers, Karlien François

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Abstract

Heparin is the most widely used anticoagulant for maintaining patency of the extracorporeal blood circuit during intermittent hemodialysis. Inadvertently, this leads to systemic heparinization of the patient. Repeated intermittent heparinization during hemodialysis has been associated with increased bleeding risks and metabolic and immunologic effects. Alternative strategies for minimizing systemic anticoagulation encompass dilution methods, regional citrate anticoagulation, priming of the extracorporeal circuit, and modifications to dialyzer membranes and dialysate composition. The effectiveness of these alternatives in maintaining patency of the extracorporeal circuit varies substantially. Although most studies have focused on particular changes in the hemodialysis setup, several combined interventions for adapting the hemodialysis setup are now being studied. This narrative review aims to present an overview of the current landscape of hemodialysis setup strategies aimed at limiting or avoiding systemic anticoagulation during treatment. Additionally, this review intends to shed light on the underlying pathophysiological mechanisms that contribute to variations observed in reported outcomes.

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在血液透析过程中避免全身肝素化：透析装置如何提供帮助？

肝素是间歇性血液透析过程中维持体外血路通畅最广泛使用的抗凝剂。这无意中会导致患者全身肝素化。血液透析期间反复间歇性肝素化与出血风险增加以及代谢和免疫学影响有关。最大限度减少全身抗凝的替代策略包括稀释方法、区域性枸橼酸盐抗凝、体外循环引流以及透析膜和透析液成分的调整。这些替代方法在保持体外循环通畅方面的效果差别很大。虽然大多数研究都集中在血液透析装置的特定改变上，但目前正在研究几种调整血液透析装置的综合干预措施。本综述旨在概述目前旨在限制或避免治疗期间全身抗凝的血液透析设置策略。此外，本综述还旨在阐明导致报告结果差异的潜在病理生理机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in nephrology 医学-泌尿学与肾脏学

CiteScore

5.60

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to the clinical practice of nephrology. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training.