Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy

Raina, Rupesh; Chakraborty, Ronith; Davenport, Andrew; Brophy, Patrick D.; Sethi, Sidharth Kumar; McCulloch, Mignon; Bunchman, Timothy E.; Yap, Hui Kim

doi:10.1007/s00467-021-05020-z

Cited by 8 publications

(2 citation statements)

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“…Haemodialysis involves blood circulation through an extracorporeal circuit and artificial kidney (dialyser), both of which contribute to the activation of coagulation pathways (Ashby et al., 2019 ; ElSayed et al., 2023 ; Suranyi & Chow, 2010 ). Coagulation of the system usually does not prevent the completion of treatment, but it reduces the effectiveness of the dialytic removal of various solutes, including phosphate (Kuhlmann, 2010 ; Raina et al., 2022 ; Suranyi & Chow, 2010 ). Routine anticoagulation is infused during treatment to prevent extracorporeal circuit clotting and therefore constitutes an essential part of the effective delivery of HD therapy (Barreto et al., 2019 ; Bowry et al., 2021 ; Kessler et al., 2015 ; Suranyi & Chow, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

“…Overheparinization during HD can lead to prolonged bleeding from vascular access, in addition to intracranial and gastrointestinal haemorrhage (Herrington et al., 2015 ; Jalal et al., 2010 ; Kessler et al., 2015 ; Yu‐Huan et al., 2023 ). Thus, despite the use of heparin, the tubing and dialyser fibres and membrane pores often coagulate during HD treatment (Bowry et al., 2021 ; Kuhlmann, 2010 ; Raina et al., 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a coagulation component into a phosphate kinetics model in haemodialysis therapy: A tool for detection of clotting problems?

Laursen,

Boel,

Brandi

et al. 2023

Experimental Physiology

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A coagulation component should be considered in phosphate kinetics modelling because intradialytic coagulation of the extracorporeal circuit and dialyser might reduce phosphate removal in haemodialysis. Thus, the objective of this study was to add and evaluate coagulation as an individual linear clearance reduction component to a promising three‐compartment model assuming progressive intradialytic clotting. The model was modified and validated on intradialytic plasma and dialysate phosphate samples from 12 haemodialysis patients collected during two treatments (HD1 and HD2) at a Danish hospital ward. The most suitable clearance reduction in each treatment was identified by minimizing the root mean square error (RMSE). The model simulations with and without clearance reduction were compared based on RMSE and coefficient of determination (R2) values. Improvements were found for 17 of the 24 model simulations when clearance reduction was added to the model. The slopes of the clearance reduction were in the range of 0.011–0.632/h. Three improvements were found to be statistically significant (|observed z value| > 1.96). A very significant correlation (R2 = 0.708) between the slopes for HD1 and HD2 was found. Adding the clearance reduction component to the model seems promising in phosphate kinetics modelling and might be explained, at least in part, by intradialytic coagulation. In future studies, the model might be developed further to serve as a potentially useful tool for the quantitative detection of clotting problems in haemodialysis.New Findings What is the central question of this study? The aim was to add an intradialytic coagulation component to a modified version of a promising three‐compartment phosphate kinetics model. The hypothesis was that circuit and dialyser clotting can be modelled by an individual linear phosphate clearance reduction component during haemodialysis treatment. What is the main finding and its importance? Improvements were found for 17 of 24 model simulations when clearance reduction was added to the model. Thus, the kinetics model seems promising and could be a useful tool for the quantitative detection of clotting problems in haemodialysis patients.

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