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| 출혈위험이 있는 신부전 환자에서의 혈액투석 |
| 문현창 , 하기수 , 조성욱 , 문성수 , 유병희 , 이학중 |
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| Abstract |
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Anticoagulation during hemodialysis is necessary to prevent coltting of the blood on contact with the dialysis membrane. But systemic heparinization can produce hemorrhagic complications in those patients who are at high risk of bleeding. To solve this dilemma we compar- ed heparin free hemodialysis with systemic hepariniza- tion, regional heparinization, intermittent saline flushes and constant saline infusion in 13 chronic patients. After that, we prospectively studied 10 patients with high risk of bleeding usiog heparin free dialysis. The following results were obtained: 1) The percent of fiber-bundle volum loss was in- creased significantly in the saline infusion and heparin free groups compared to the systemic heparinization gl Oup. 2) The five groups did not differ significantly with regard to weight loss, changes in BUN and serum creatinine, or changes in dialyzer urea or crestinine clearance. 3) All heparin free hemodialyses on 10 patients with high risk of bleeding were performed successfully, but moderate clotting occurred in 15 treatments. 4) There were no significant differences in blood flow, blood pressure, hematocrit and blood transfusion according to the severity of clotting in patients with heparin free dialysis. In conclusion, heparin free hemodialysis is considered as a safe, simple and effective therapeutic strategy in patients with high risk of bleeding. |
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