Assessing the contact‐activation of coagulation during hemodialysis with three different polysulfone filters: A prospective randomized cross‐over trial

Salvadé, Igor; Giorno, Rosaria Del; Donato, Gaetano; Gabutti, Luca

doi:10.1111/hdi.12509

Cited by 6 publications

(5 citation statements)

References 32 publications

(64 reference statements)

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“…There was no difference in small solute, urea clearances when using the two dialyzers, and no difference in convective exchange. We found that D-dimers increased in the dialyzer outlet samples with both dialyzers, in keeping with previous reports using PS dialyzers, 23 but there was no significant increase in TATs post-dialyzer or increase with treatment duration. This small difference may potentially be due to the higher sieving coefficient and larger membrane surface area, although as we only made blood side measurements cannot exclude any membrane adsorption.…”

Section: Discussionsupporting

confidence: 92%

“…To study whether these changes in clotting cascade proteins lead to clot formation, we measured D-dimers and TATs. We found that D-dimers increased in the dialyzer outlet samples with both dialyzers, in keeping with previous reports using PS dialyzers, 23 but there was no significant increase in TATs post-dialyzer or increase with treatment duration. These results demonstrate that clot formation was minimal, as earlier studies have reported increased TATs within minutes of starting hemodialysis.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Tangvoraphonkchai

Riddell

Davenport

2017

Hemodialysis International

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Tangvoraphonkchai

Riddell

Davenport

2017

Hemodialysis International

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“…In the first one, comparing the same two membranes, we demonstrated, by measuring higher D-dimer levels in the dialyzer rinsing fluid, that the contact activation of coagulation during HD was more pronounced for Filter A in comparison with Filter B. 24 Even though it is not possible to draw conclusions, we can speculate that these findings might be related. Furthermore, interactions between coagulation and complement systems were extensively analyzed, and the involvement of the PSf HD membranes in complement pathway was demonstrated in proteomic studies on protein adsorption pattern performed with biomaterials used for HD membranes.…”

Section: Discussionmentioning

confidence: 87%

Comparative analysis of the long-term effect of two families of high-flux polysulfone dialysers on platelet count: a retrospective cross-sectional study

Giorno

Berwert

Pianca

et al. 2017

TCRM

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IntroductionThrombocytopenia is a potential complication of hemodialysis (HD), and its occurrence has been described even with highly biocompatible polysulfone (PSf) membranes. Dialysis units routinely monitor platelet (PLT) count at the beginning of HD sessions. However, considering that the long-term effects on PLT count could easily be missed, the prevalence of HD-related thrombocytopenia could be underestimated. In the present study, we aimed to investigate the following: 1) the long-term impact of HD treatment on PLT count, comparing two families of dialysis membranes made up of similar PSfs; 2) whether the switch between the dialysis membranes studied significantly affects PLT count; and 3) the prevalence and the risk of HD-induced thrombocytopenia according to the dialysis membranes used.MethodsA cross-sectional retrospective study was performed comprising 157 adult chronic HD patients. The HD membranes under investigation were of the series FX, Helixone® Fresenius (Filters A), and Polyflux® Gambro (Filters B). Patients were treated in 4 dialysis units in Southern Switzerland. Data were collected from a centralized computing platform.FindingsPLT count significantly differs between Filters A and B with, respectively, 188 (153–243) ×10E9/L versus 214 (179–255) ×10E9/L (p=0.036). The prevalence of thrombocytopenia was higher for Filter A compared with Filter B (28.4% versus 12.8%; p<0.001). The switch from Filter A to Filter B significantly affected PLT count: from 189 (146–217) ×10E9/L to 217 (163–253) ×10E9/L (p<0.001; analysis on 26 patients). A linear random-intercept model confirmed the results (β coefficient =35.214; SE =5.956; p<0.001). In a mixed-effects logistic regression model, the risk of thrombocytopenia for Filter B was 0.157 (CI =0.056–0.442).DiscussionOur data suggest that among the PSf membranes studied, the FX membrane induced a lasting decrease in PLT count and caused significantly more thrombocytopenia. Prospective studies are warranted to verify our findings.

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“…Others are assessed offline, such as visual 6 – 10 or software assisted 7 dialyzer redness scoring. Also laboratory parameters representing coagulation activity in general 6 – 8 , 11 – 13 , measured solute clearance 6 , 14 , evaluation of rinse-back 3 or fiber bundle volumes 15 – 17 and electron microscopy 9 have been used. None of these parameters is robust, objective or accurate, which limits the comparative study of different strategies to reduce coagulation and fiber blocking.…”

Section: Introductionmentioning

confidence: 99%

Micro-computed tomography for the quantification of blocked fibers in hemodialyzers

Vanommeslaeghe

Biesen

Dierick

et al. 2018

Sci Rep

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A novel technique based on micro-CT scanning is developed to quantify coagulation in fibers of hemodialyzers. This objectivation is needed to allow accurate assessment of thrombogenicity of dialyzers used during hemodialysis, for example when comparing different strategies to avoid coagulation and/or fiber blocking. The protocol allowed imaging at a resolution of 25 µm, making it possible to count the open, non-coagulated fibers in a non-invasive way. In 3 fresh, non-used FX600 hemodialyzers, patent fiber counts were extremely consistent (10748 ± 2). To illustrate the potential of this technique, different dialysis parameters currently used as surrogates for fiber blocking were evaluated during 20 hemodialysis sessions. After dialysis, the FX600 dialyzers were visually scored for clotting, dried and subsequently weighed and scanned. The number of patent fibers (10003 [8763,10330], range 534–10692) did not correlate with any of the recorded surrogate parameters. Micro-CT scanning is a feasible, objective, non-invasive, accurate and reproducible tool for quantification of the degree of fiber blocking in a hemodialyzer after use, making it a potential gold standard for use in studies on fiber blocking during renal replacement therapies.

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Assessing the contact‐activation of coagulation during hemodialysis with three different polysulfone filters: A prospective randomized cross‐over trial

Cited by 6 publications

References 32 publications

Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Comparative analysis of the long-term effect of two families of high-flux polysulfone dialysers on platelet count: a retrospective cross-sectional study

Micro-computed tomography for the quantification of blocked fibers in hemodialyzers

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