Please select the eligibility criteria that correspond to the clinical trial below.
Title: Dialysis Adequacy and Clotting Complications During Anticoagulation-free Hemodialysis Using a Heparin-grafted Dialyzer and a Citrate-enriched Dialysate: a Prospective Randomized Crossover Study. (EvoCit-HD Study)
Brief Summary: After providing informed consent, patients will be randomized to either the intervention treatment ("EvoCit procedure") or the control treatment ("EvoHep procedure").

After randomization, each study arm consists of four weeks of 3x4 hours hemodialysis treatments according to the allocated protocol. After the last dialysis treatment of the fourth treatment week and after a long interdialytic interval, patients will crossover to the alternative hemodialysis procedure. After crossover, the study will be completed with, again, four weeks of 3x4 hours hemodialysis treatments according to the allocated protocol.


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:

* Prevalent NHHD patients who have received \>1 year dialysis with unfractionated heparin as anticoagulant
* Age \>= 18
* Informed consent available

Exclusion Criteria:

* History of intolerance to LMWHs during HD
* Receiving warfarin or other oral anticoagulant
* Pregnant patients
C: 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

  1. use of urokinase the 2 months before study inclusion, including to restore catheter permeability.
  2. non-tunneled hemodialysis catheter use.
  3. known AV access outflow tract stenosis.
  4. planned vascular access intervention.
  5. 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
D: Inclusion Criteria:

1. hemodialysis patients with age \> 18 years on regular bicarbonate hemodialysis or hemodiafiltration treatment three times a week;
2. clinical stability at least three months before the study started;

Exclusion Criteria:

1. active gastrointestinal bleeding (one ore more positive hemoccult test in the last 8 weeks, melena or proctoraggia in the last 6 months )
2. hemorrhagic stroke
3. Myeloproliferative disorders
4. Hereditary deficiency of coagulation factors, LAC phenomenon or antiphospholipid syndrome
5. Malignant disease
6. Patient submitted to antithrombotic prophylaxis with LMWH
7. Immunosuppressive therapy
8. Participation in other clinical trials

Answer: C