Effect of Heparin Dosage on Adequacy of Haemodialysis
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Abstract
Background: Adequate anticoagulation is essential for maintaining extracorporeal circuit patency during haemodialysis and preventing subclinical clotting that may reduce dialyzer efficiency and solute clearance. Empiric weight-based heparin regimens are widely used but may not account for inter-patient variability in anticoagulation requirements. Objective: To evaluate the effect of individualized heparin dosing guided by pharmacokinetic modelling and activated clotting time monitoring on haemodialysis adequacy compared with empiric dosing. Methods: This prospective observational study was conducted in the Nephrology Department of Pak Emirates Military Hospital from 1st March to 31st August 2023. Twenty-eight clinically stable maintenance haemodialysis patients receiving thrice-weekly dialysis were enrolled. Baseline dialysis was performed using empiric heparin regimens, followed by an intervention phase using individualized dosing. Outcomes included heparin dose, effective clearance, pre-dialysis urea, time-averaged concentration of urea, hematocrit, and normalized protein catabolic rate. Results: Mean heparin dose increased from 2175.3 ± 345.8 IU to 4461.7 ± 782.5 IU. Effective clearance improved from 209.2 ± 33.5 to 238.3 ± 34.7 mL/min, pre-dialysis urea decreased from 83.7 ± 16.4 to 74.4 ± 15.0 mg/dL, and time-averaged concentration of urea declined from 50.2 ± 22.5 to 39.3 ± 21.7 mg/dL, with all comparisons showing statistical significance. Hematocrit remained unchanged and no bleeding complications were reported. Conclusion: Individualized heparin dosing improved dialysis adequacy and solute control without compromising short-term safety, supporting monitoring-based anticoagulation as a practical alternative to empiric regimens
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