Anticoagulation Outcomes and Associated Factors among Acute Kidney Injury Patients during Hemodialysis at Two Selected Hospitals in Addis Ababa, Ethiopia: A Prospective Study
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Date
2023-11
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Addis Ababa University
Abstract
Background: During hemodialysis (HD), clots in the dialyzer reduce the effective surface
area of the dialyzer and in extreme situations clots in the circuit may prevent treatment from
continuing and result in loss of blood in the circuit. Anticoagulation is essential during HD to
prevent clot formation the circuit without putting the patient at risk of bleeding.
Objective: The study aimed to assess anticoagulation outcomes and associated factors among
Acute Kidney Injury (AKI) patients during HD at Tikur Anbessa Specialized Hospital
(TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa,
Ethiopia.
Method: A prospective, multicenter observational study was conducted between October 1st,
2021, and March 31st, 2022, at TASH and SPHMMC in Addis Ababa, Ethiopia. The study
included all AKI patients who were undergoing HD at least once during the study period.
Descriptive statistics were used to summarize the data while multinomial logistic regression
analysis was used to determine factors associated with clotting and bleeding.
Results: Data were extracted from 1010 HD procedures performed on 175 patients.
Extracorporeal circuit clotting occurred in 34 patients in 39 (3.9%) dialysis sessions, and 27
patients in 29 (2.9%) sessions had experienced bleeding. The total number of HD sessions
(AOR=1.932, 95% CI, 1.227-3.043) and blood flow rate (AOR=0.868, 95% CI, 0.812-0.928)
showed a statistically significant association with clotting. Bleeding was associated with
length of hospitalization (AOR=1.247, 95% CI, 1.053-1.478), serum creatinine at admission
(AOR=1.886, 95% CI, 1.285-2.769), uremic signs and symptoms (AOR=0.092, 95% CI,
0.009-0.955), and use of an anticoagulant and/or antiplatelet drug (AOR=0.017, 95% CI,
0.001-0.446).
Conclusion: A comparable number of circuit clotting was found when compared to other
studies. However, it resulted in treatment interruptions and blood loss. Additionally, the study
revealed a notable incidence of bleeding during HD, with most cases being minor.
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Keywords
Acute kidney injury, Anticoagulation, Hemodialysis, Ethiopia.