Hemodialysis Adequacy Using a Heparin-grafted Dialyzer and a Citrate-enriched Dialysate

Inclusion criteria

• Patients treated with hemodialysis or hemodiafiltration since at least three months.
• Hemodialysis or hemodiafiltration prescription of 3 x 4 hours weekly.
• ≥ 18 years of age.
• Patients able and agree to provide signed informed consent.

Exclusion criteria

• Contraindication to heparin defined as known heparin-induced thrombopenia or active bleeding risk with contra-indication for systemic anticoagulation, categorized as defined by Swartz and Port1.
• Planned surgery during study period, including scheduled living-donor kidney transplantation during study period.
• Hypercoagulable state defined as known malignancy, known APC resistance/FV Leiden, known prothrombin gene mutation, known protein C or protein S deficiency, known antithrombin deficiency.
• Mean Qb of <300ml/min during one of the last 3 dialysis sessions before inclusion.
• 1 or more results of spKt/Vurea < 1,35 during the last three months prior to study inclusion.
• Need for 2 or more supplementary dialysis sessions on top of the regular 3x4 hours weekly hemodialysis regimen during the last month before inclusion.
• Vascular access dysfunction defined as

• use of urokinase the 2 months before study inclusion, including to restore catheter permeability.
• non-tunneled hemodialysis catheter use.
• known AV access outflow tract stenosis.
• planned vascular access intervention.
• planned vascular access conversion.
• Known allergy against heparin grafted AN69STmembranes.
• Use of ACE-inhibitor
• Use of vitamin K antagonist
• Use of novel oral anticoagulant therapy.
• Any medical condition, which puts the patient at risk of premature study termination in the opinion of the investigator.
• Planned conversion of dialysis modality during study period or planned absence/leave (including pregnancy or planned pregnancy).
• Symptomatic hypocalcemia.
• Hb < 8g/dl at screening.
• Hct > 45% at screening.
• Perdialytic total parenteral nutrition therapy