الفهرس 
Coagulation process and ESRDOnly 14 pages are availabe for public view
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Abstract
Hemodialysis is a recognized standard treatment for patients with end stage kidney disease.
Prevention of clotting in the extracorporeal circuit was one of the major hurdles that had to be overcome to enable the expansion of routine outpatient hemodialysis to free-standing satellite centers and the home. Unfractionated heparin, the anticoagulant of choice ( due to low cost, availability, short half-life, and reversibility ) for many years, is now being replaced by low-molecular-weight heparins (LMWHs) in an expanding number of countries. This trend is attributable to the ease and convenience of the administration of LMWHs coupled with their reliability and predictability of dosing. However, the choice of which LMWH to use depends on the duration and frequency of the dialysis sessions. But still the UFH is the superior hemodialysis anticoagulant in most countries and Egypt.
For patients who are allergic to heparin or have heparin-induced thrombocytopenia, alternative anticoagulants—the direct thrombin inhibitors and heparinoids—are now available. These agents either have short half-lives (and therefore need to be delivered by infusions), or prolonged half-lives, which allows simple bolus administration, but increases the risk of drug accumulation, overdosage and hemorrhage.
In patients at risk of bleeding or patients with Heparin-induced thrombocytopenia and thrombosis, regional citrate anticoagulants enable anticoagulation to be limited to the extracorporeal circuit. In respect to heparin, citrate is emerging as being similar or even superior as anticoagulant in terms of filter life and efficacy of anticoagulation. But metabolic consequences due to use of citrate is still a challenge so its not commonly used in clinical practice for routine outpatient hemodialysis.
Prostanoids and nafamostat mesilate are expensive regional anticoagulants.