The Current Status Of Anticoagulant Treatments And Improvements For Hemodialysis Patients In Northern Chinese Cities: A5-year Comparative Study

Background: Anticoagulation treatments are an important aspect of hemodialysis;insufficient or excessive anticoagulant use can lead to hemorrhage or thrombosis. Onthe other hand, appropriate vascular access in hemodialysis is another important aspectof hemodialysis. However, few clinical guidelines or reports have addressed thesetreatments. In this study, an epidemiological investigation was conducted and theobjective was to achieve the following purposes:①to increase the understanding of thecurrent status of hemodialysis-related anticoagulation treatments in China;②to increasethe understanding of the current status of vascular access in hemodialysis and toevaluate hemodialysis-related anticoagulation treatments and the associatedhemorrhagic or thrombotic complications and③to determine how hemodialysis-relatedanticoagulation treatments in China have improved following governmental promotionof the “Blood Purification Standard Operating Procedure”.Methods: An epidemiological investigation was conducted that examined842patients in2007and1,175patients in2012who underwent hemodialysisanticoagulation treatments in seven blood purification centers in northern Chinese cities.The population from2012was further divided into two groups based on the vascularaccess they used: group1: arteriovenous fistula (AVF); and group2: central venouscatheter (CVC).Results:①Heparin was the most commonly used anticoagulant, although thepercentage of low-molecular-weight heparin （LMWH） increased from26.5%in2007to42.1%in2012；②In2007, there were no significant differences in anticoagulantselection among either patients with various primary diseases or patients withhemorrhage, thrombosis, thrombocytopenia, or a low hemoglobin level. Significantly lower doses of LMWH were administered to patients with hypertension or diabetescompared with the others. In addition, patients with hemorrhage received lower doses ofheparin than the others. In2012, patients with diabetic nephropathy, hemorrhage, or ahemoglobin level below90g/L experienced significantly greater rates of LMWHadministration; patients with hemorrhage received significantly reduced LMWHdosages, and patients with thrombosis received significantly higher doses of heparin orLMWH；③In2007, antiplatelet drugs were administered to20.4%of the examinedpatients, with no significant differences in the rates at which these drugs wereadministered to patients with different primary diseases. In2012, antiplatelet drugs wereadministered to20.7%of patients at significantly higher rates to patients withhypertension and patients with thrombosis than to the other examined patients. However,the use of the drugs was not correlated with thrombocytopenia. Patients receivingantiplatelet drugs also received significantly higher doses of heparin than other patients；④The rate at which coagulation indices were determined increased from45.7%ofpatients in2007to64%of patients in2012. And in2012, the rate was significantlyhigher among patients with hemorrhage or thrombosis compared with other patients；⑤Arteriovenous fistula was the most frequently used vascular access，Patients in groupCVC experienced significantly greater rates of LMWH administration, and had a higherrate in achieving thrombotic complications than group AVF. There were no significantdifferences in LMWH dosages in patients with thrombotic complications in group CVC,as well as the proportion of patients who received antiplatelet drugs；⑥Heparinizedcatheter lock solutions were excessively high in this study, which may lead to a risk ofhemorrhage.Conclusions: As the “Blood Purification Standard Operating Procedure” has beenpromoted in China, general anticoagulation treatments for hemodialysis patients havegradually become more standardized, and increasing attention has been devoted toaccounting for the individual characteristics of each patient. However, additionalimprovements are required regarding the selection of anticoagulant drugs, thedetermination of anticoagulant doses, the administration of antiplatelet drugs and the assessment of anticoagulation statuses. More attention should be given to the patientswho used CVC as vascular access. There is an urgent need to develop clinical practiceguidelines for administering anticoagulation treatments to hemodialysis patientsbecause these guidelines could provide recommendations that further standardize andregulate the treatments and enhance the quality of hemodialysis therapies.