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Prolonged hemodialysis (HD) has stood out for its ease of application and shorter duration of therapy than continuous HD (> 6 to 12 hours). The use of the Genius® hybrid system offers advantages such as bacteriological safety, and a portable, hermetically sealed tank with thermal insulation. However, prolonged HD is not exempt from complications. Therefore, this study aims to analyze the adverse outcomes of patients undergoing prolonged HD with the Genius® hybrid system, with special attention given to the anticoagulation method.
A retrospective cohort study at a University Hospital Nephrology Unit. Exposure: Patients on prolonged HD (> 6 hours) in a Genius® hybrid system. Anticoagulation was with three methods: washing the extracorporeal system with 0.9% saline, regional anticoagulation with 4% sodium citrate, or systemic anticoagulation with unfractionated heparin. The following adverse outcomes have been registered: thrombosis, intradialytic hypotension, hypertension, fluid and electrolyte disorders, dysnatremia, acidosis, alkalosis, citrate intoxication, bleeding, death, and days in the Intensive Care Unit (ICU). Inclusion criteria were patients > 18 years old with acute kidney injury (AKI) or chronic kidney disease (CKD) who underwent exposure from 03-09/2023. Data have been collected from electronic medical records and managed on the REDCap® platform. Statistical analysis used IBM SPSS Statistics version 29.0.1.0 software (171). The University Ethics Committee approved the study (Report No. 5,816,491).
A total of 54 patients were included and 296 prolonged Genius® hybrid system HD sessions were evaluated. Most were men n=33 (61.1%), average age of 73.3 years (±13.4), and had hypertension n=40 (74%), diabetes n=21 (38.9%), and obesity n=16 (29.6%). Most sessions (59.1%) used saline lavage as an anticoagulation method, followed by unfractionated heparin (33.4%) and sodium citrate (7.2%). The patient sample presented an elderly, male, a hypertensive profile, with multi-comorbidities and a diagnosis of AKI. Other clinical characteristics are presented in Table 1. Concerning the adverse outcomes of dialysis sessions, intradialytic hypotension (IDH) was the most frequent ( 40.9%), followed by System Coagulation (28.7%). Other outcomes were described in Table 2. There was no bleeding, hyponatremia, citrate poisoning or alkalosis. The occurrence of death was 66.7% and the average stay in the ICU was 14.7 days.
The study demonstrates high mortality in the sample and an average stay in the ICU of two weeks. These values may be related to the profile of the patients: multi-comorbid elderly individuals admitted to the ICU. Intradialytic hypotension and system thrombosis were the most frequent complications. The most used anticoagulation method was line and filter washing with 0.9% saline, which may have had an impact on the reported rate of thrombosis. This fact is due to the lack of reimbursement for the use of citrate anticoagulation by the public health system.