Impact of Hemodialysis on Bleeding Tendency in End Stage Renal Disease Patients

Abstract

Background: Heparin is a potent anticoagulant with diverse pleiotropic effects through cytokine release. In hemodialysis, anticoagulation using systemic heparinization is crucial to prevent blood clots within the extracorporeal circuit. However, the risk of bleeding complications and substantial hemostatic defects are increased in maintenance HD patients. Aim of work: the aim of the presented study was to investigate the effect of systemic heparinization during hemodialysis on the coagulation profile of maintenance HD patients and whether heparin free dialysis would be beneficial for specific patients. Patients and Methods: Sixty ESRD patients on regular HD three times per week and 25 healthy controls were recruited to this study. Complete blood count, prothrombin time, activated partial prothrombin time, fibrinogen and D-dimer levels pre and post hemodialysis were evaluated. Results:The presented study demonstrated prolongation of PTand APTT associated with increased levels of fibrinogen and D-dimer post HD (p-value: <0.0001). Conclusion:The prolonged PT and APTT in addition to the rise in fibrinogen and D-dimer levels post HD indicates that the prophylactic anticoagulantion using unfractionated heparin could increase the risk of bleeding in HD patients.