Please select the eligibility criteria that correspond to the clinical trial below.
Title: Chronic Hemodialysis Without Systemic Heparinization : a Randomized Study
Brief Summary: Conventional hemodialysis requires transient systemic anticoagulation to prevent blot clotting after contact with the extracorporeal circuit. However, low molecular weight heparin (LMWH) or unfractioned heparin are contra-indicated in dialysis patients at risk for hemorrhagic complications. In this setting, several procedures theoretically allow dialysis without systemic heparinization, but randomized studies to compare them are lacking. The gold standard is the use of iterative rises of the extra corporeal circuit with isotonic saline (" rises "). Two emerging procedures are increasingly used : continuous pre-dilution of the arterial line (" pre-dilution ") and the use of a specific dialysis membrane (NEPHRAL 400 ST) coated with heparin immediately before use (" heparin adsorption ").


Options:
A: Inclusion Criteria:

* Age \>= 18 years
* End stage renal disease maintained on outpatient hemodialysis for \>= 3 months
* Frequency of hemodialysis: 3 times per week
* Anticoagulation with an unfractionated heparin protocol for at least 4 weeks
* Patient or legal guardian able to provide written consent
* Baseline INR \<= 1.3
* Baseline platelet count \>= 80,000 x 10\^9/L

Exclusion Criteria:

* Therapeutic systemic anticoagulation
* Clinically apparent bleeding in the last 2 months
* High risk of bleeding
* Planned major surgery in the next 4 months
* Major surgery in the past 48 hours
* Pregnant or lactating
* Child bearing potential
* Allergy/intolerance to heparin or history of heparin induced thrombocytopenia
* Current participation in a related randomized drug trial
B: Inclusion Criteria:

* Chronic hemodialysis patient
* Low molecular weight heparin contra indicated for at least 3 consecutive hemodialysis sessions.

Exclusion Criteria:

* Acute renal failure
* Access flow \< 250 ml/mn)
* Per dialytic Blood transfusion or parenteral nutritional support
* Systolic BP \< 80 mm Hg
* Hemoglobin \> 13 g/dl
C: Inclusion Criteria:

1. Critically ill patients with clinical indication for CRRT (clinical decision to use continuous RRT due to hemodynamic instability)

   Or

   Severe acute kidney injury (KDIGO 3-classification) despite optimal resuscitation
2. At least one of the following conditions

   * Sepsis or septic shock
   * Use of catecholamines (norepinephrine or epinephrine ≥ 0.1 µg/kg/min or norepinephrine ≥ 0.05 µg/kg/min + dobutamine (any dose) or norepinephrine ≥ 0.05 µg/kg/min + vasopressin (any dose) or epinephrine ≥ 0.05 µg/kg/min + norepinephrine ≥ 0.05 µg/kg/min)
   * Refractory fluid overload: worsening pulmonary edema: PaO2/FiO2 \< 300 mmHg and/or fluid balance \> 10% of body weight)
3. 18-90 years old
4. Intention to provide full intensive care treatment for at least 3 days
5. Written informed consent of the patient or the legal representatives or the authorized representative or the inclusion due to an emergency situation

Exclusion Criteria:

1. Patients with increased bleeding risk (e.g. an active bleeding from ulcers in the gastro-intestinal tract, hypertension with a diastolic blood pressure higher than 105 mm Hg, injuries (intracranial hemorrhage, aneurysm of brain arteries) of or surgical procedures on the central nervous system if a heparinization with a target aPTT 45-60 s is not allowed by the treating neurologist or neurosurgeon, severe retinopathies, bleeding into the vitreum, ophthalmic surgical procedures)) or injuries, active tuberculosis; infective endocarditis)
2. Disease or organ damage related with hemorrhagic diathesis (coagulopathy, thrombocytopenia, severe liver or pancreas disease)
3. Dialysis-dependent chronic kidney insufficiency
4. Need of therapeutic systemic anticoagulation
5. Allergic reaction to one of the anticoagulants or ingredients, Heparin-induced thrombocytopenia
6. AKI caused by permanent occlusion or surgical lesion of the renal artery
7. AKI caused by (glomerulo)nephritis, interstitial nephritis, vasculitis or postrenal obstruction
8. Do-not-resuscitate order
9. Hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura
10. Persistent and severe lactate acidosis in the context of an acute liver failure and/or shock
11. Kidney transplant within the last 12 months
12. Pregnancy and nursing period
13. Abortus imminens
14. No hemofiltration machine free for use at the moment of inclusion
15. Participation in another clinical intervention trial in the last 3 months
16. Persons with any kind of dependency on the investigator or employed by the sponsor or investigator
17. Persons held in an institution by legal or official order
D: Inclusion Criteria:

* Patients aged over 18 years,
* hemodynamic stability,
* hemoglobin 9 - 12 g/dl.

Exclusion Criteria:

* Any hemostatic disorder favoring either bleeding or clotting,
* anti-vitamin K treatment,
* risk of bleeding according to the criteria of Swartz (12).

Treatment with aspirin, dipyridamole or any drugs likely to interfere with platelet aggregation will be registered carefully, but will not be an exclusion criterion.

All vascular access types (AV-fistula, AV graft, catheter) are allowed. However, only patients with double route vascular access ('bipuncture') will be included in the study.

Answer: B