Heparin-Free Chronic HemoDialysis Assessment

Inclusion criteria

• Man or woman aged 18 years or more
• Patients with end-stage renal disease (ESRD) under intermittent hemodialysis, for more than 3 months prior to screening and with a dialysis duration prescription of at least 4 hours
• Effective anticoagulation either by UFH or by LMWH of the dialysis session defined by the absence of circuit loss in the last 3 months.
• Dialysis adequacy defined by a mean Kt/V ≥1.2.
• Calcemia within the normal range at inclusion (2.2 to 2.6 mmol/L) (based on the results of the last monthly blood test)
• Subject affiliated to or beneficiary of a social security system.
• Subject having signed written informed consent.

Exclusion criteria

• Dysfunctional vascular access at the screening
• Unipunction of the AVF
• Patient treated by hemofiltration or hemodiafiltration procedure
• Current anticoagulation treatment
• Patient treated by digitalizing drugs
• Patient treated by thiazide diuretics
• Patient with hypercalcemia and/or hypercalciuria
• History of sensitivity to heparin or heparin-induced thrombocytopenia.
• Active hemorrhage
• High bleeding risk defined by the following situations: recent bleeding of less than 7 days, recent post-operative period of less than 7 days, recent head trauma of less than 7 days, recent ischemic stroke of less than 7 days, uremic pericarditis.
• Body weight < 45 kg and > 140 kg at screening.
• Known allergy to citrate
• Hospitalization at the screening for all other causes apart from dialysis
• Moribund status (defined by the expectation of death in less than three months).
• Liver failure (to prevent citrate liver toxicity) based on the results of the last monthly or quarterly blood test
• Ongoing participation in a concurrent interventional study in dialysis or with anti-coagulation therapy
• Pregnancy (declarative) or breastfeeding and all the other categories of people with special protection according to the French Code de la Santé Publique (CSP): patients under legal supervision, patients hospitalized without consent, patients admitted in social or sanitary structures for care and not research, and patients in emergency situations
• Patients unable to give an informed consent or unwilling to participate in the study.
• Heparin-coated membrane in current dialysis prescription