Anticoagulation in Haemodialysis
Research type
Research Study
Full title
A prospective case-controlled observational study comparing the impact of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) on the coagulation profile of patients undergoing haemodialysis.
IRAS ID
130874
Contact name
Suzanne Forbes
Contact email
Sponsor organisation
Queen Mary University London
Research summary
Haemodialysis is a life-sustaining treatment for patients with end-stage kidney disease. It involves ‘cleaning’ their blood using an ‘artificial kidney’ (dialysis machine), usually for 4 hours thrice weekly. During haemodialysis, blood which is removed from the body can clot, blocking the tubes in the machine, causing the machine to malfunction and leading to substandard dialysis. To avoid this, blood-thinning treatment (anticoagulation) with unfractionated heparin (UFH) or low-molecular weight heparins (LMWH) is administered during each haemodialysis session. Although UFH and LMWH are effective anticoagulation agents, they each have advantages and disadvantages. For example, one well-documented side-effect of both agents is the development of antibodies (the attacking part of the immune system) leading to a life-threatening condition called heparin-induced thrombocytopenia (HIT); this is more common with UFH than LMWH.
Currently, there are no guidelines for the choice or dosing of anticoagulation during haemodialysis. More importantly, no reliable or quick laboratory test exists to assist doctors with dosing of anticoagulation. Knowing that patients with ESRD are at increased risk of both bleeding and clotting, under- or over-dosing of anticoagulation during haemodialysis could exacerbate these risks and thus increase morbidity and mortality of these patients. Careful and balanced anticoagulation is key to effective haemodialysis treatment. In the last few years new clotting tests have been developed that might assist clinicians with dosing of anticoagulation during haemodialysis.
This study aims to compare, using both standard and novel clotting tests, the impact of UFH and LMWH given during haemodialysis on coagulation profiles. We will also compare the bleeding risks and the frequency of HIT antibodies for each group. Patients will be recruited from Barts Health dialysis units and Southend Hospital. For the purpose of this study, extra blood samples will be taken at 4 different time points, however, patients’ treatment will not be altered.
REC name
London - Stanmore Research Ethics Committee
REC reference
13/LO/1273
Date of REC Opinion
17 Sep 2013
REC opinion
Favourable Opinion