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Blood flow was ordered at 400 mL/min and only decreased ankyrin if the access could not support that number. Dialysate did not contain citrate. After each HD session, dialysis catheters were locked with 5000 units/mL of heparin to fill the dead space of each of the venous and arterial sides, the amount depending on the brand of double lumen catheter. Prior to each treatment, the heparin was removed by extracting 3�C5 mL of blood from each catheter port, which was discarded and a separate syringe filled with NS flushed both ports of the catheter. The anticoagulation-free protocol consisted of Priming the hemodialyzer with 0.9% NS at a pump speed (PS) of 200 mL/min. Recirculating the NS at PS 500 mL/min for 30 s or until all air has been removed from the bloodlines and hemodialyzer. Continued recirculation of the NS at PS 200 mL/min for 10 min. During the HD treatment, the hemodialyzer is flushed every 15 min with 100 mL of 0.9% NS. This is achieved by clamping off the bloodline and opening up a preattached bag of NS to the blood pump until 100 mL had been flushed through the dialyzer. This Quisinostat solubility dmso is done using the same pump rate that is used for the blood during treatment, and thus the NS flush takes ?15�C20 s. The total volume amount of NS flushes anticipated during a treatment is precalculated into the total ultrafiltration fluid removed during the HD treatment. Unless contraindicated, blood flows of 400 mL/min are a standard order. Use of ��airless�� bloodlines. Comparisons between treatments that clotted and those that did not were done using unpaired t-tests and Fisher's exact test. Results Table ?Table11 shows the baseline patient characteristics for the 400 treatments of the 400 qualifying patients (adults requiring HD but not previously on or requiring anticoagulation before their first inpatient HD treatment). The majority of the patients had ESRD and represented the typical outpatient GSK-3 inhibitor with ESRD in the USA on HD: middle aged, African American with diabetes and hypertension. The access type reflected what may represent sicker or more chronically ill patients with the highest percentage receiving dialysis through a venous catheter (45%) and only 40% were dialyzed through a native fistula. Table 1. Baseline patient characteristics The average blood flow of all HD treatments was 378 �� 46 mL/min with AV fistulas 390 �� 30 mL/min, AV grafts 383 �� 38 mL/min and HD catheters 365 �� 56 mL/min. Reversal of arterial and venous bloodlines for low blood flow or increased venous pressure was required in 21 treatments (5.3%). Only 4 (1%) of the 400 HD treatments were associated with clotting of the hemodialyzer circuit. None of the baseline patient characteristics from Table ?Table11 was associated with clotting. Three of the four clotted treatments were seen when the bloodlines were reversed (P