Abstract
Successful heparin-free hemodialysis has been reported in adults but not in children. A preliminary study was carried out to determine whether heparin-free hemodialysis was possible in children who were considered to have a high risk of bleeding, and if so, to identify the children in whom this technique might be expected to succeed. Of 28 heparin-free procedures, 21 (75%) were successful, a major clot developed in 4, and a minor clot occurred in 3. These children were 6.76±4.57 years old and weighed 20.7±11.3 kg. An activated clotting time (ACT) of less than 170 s was recorded in five of the six patients in whom clotting was observed (normal value 146 s with a range of 110–180 s). In a second prospective study, low-dose heparin was prescribed for patients with an ACT of less than 170 s, while the remaining children again underwent heparin-free dialysis. In this study only those patients with double-lumen vascular access and a predialysis systolic blood pressure greater than 80 mmHg were included. Their mean age was 12.25±4.61 years and their weights 32.9±19.3 Kg. In 28 of 31 (90%) procedures, no clotting was observed. Minor clotting developed during the remaining 3 procedures, all in one child who weighed 8.5 kg (the only child weighing less than 10 kg). Heparin (9.6±3.2 IU/kg body weight per hour) was administered during 18 successful procedures. This study shows that heparin-free hemodialysis is possible in children, particularly, but not exclusively, those with a coagulopathy. Clotting may be anticipated in children weighing less than 10 kg and in those in whom the ACT falls below 170 s. Heparin (10 IU/kg per hour) is recommended for these patients.
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Geary, D.F., Gajaria, M., Fryer-Keene, S. et al. Low-dose and heparin-free hemodialysis in children. Pediatr Nephrol 5, 220–224 (1991). https://doi.org/10.1007/BF01095957
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DOI: https://doi.org/10.1007/BF01095957