Cellulose Triacetate Dialyzer Reduces Platelet Loss during Continuous Veno-Venous Hemofiltration

Abstract

Thrombocytopenia is a common complication in patients receiving continuous veno-venous hemofiltration (CVVH) in the intensive care unit. The hemofilter itself plays an important role in the genesis of thrombocytopenia. The present study was undertaken to test whether there were differences in platelet loss and activation during CVVH with a polysulfone (PS) hemofilter or a cellulose triacetate (CTA) dialyzer. 96 patients with thrombocytopenia and acute kidney injury requiring CVVH were randomly assigned to four groups receiving low-molecular-weight heparin (LMWH) PS (n = 24), LMWH CTA (n = 24), no anticoagulation PS (n = 24), and no anticoagulation CTA (n = 24), respectively. We found a significant decrease in platelet counts, but an increased platelet activation with the PS hemofilter in patients who received no anticoagulation. There was no significant decrease in platelet counts and activation in the CTA group. The cellulose membranes could be an effective alternative to the standard synthetic membranes in patients at high risk for thrombocytopenia during CVVH.

The incidence of thrombocytopenia associated with continuous renal replacement therapy in critically ill patients

“…6,7 The use of circuit anticoagulation, a factor which has been historically associated with reduced rates of thrombocytopenia, could have contributed to a decreased occurrence in these trials. 10 In one retrospective analysis, a similar platelet decline around 35% was seen between days 1 and 7 in patients placed on CRRT for HIT. 1 The cause of the thrombocytopenia in patients on CRRT remains to be determined.…”

“…Patients with cellulose triacetate filters and those with CRRT circuit anticoagulation had significantly lower occurrence of thrombocytopenia. 10 These authors also identified a lower rate of platelet activation with the triacetate filter by monitoring the level of bound GP IIb/IIIa. While the literature is minimal, this data signifies not only the presence of a reduction in platelets in patients on CRRT, but the relation of specific CRRT attributes to the risk and degree of platelet loss.…”

“…While the literature is minimal, this data signifies not only the presence of a reduction in platelets in patients on CRRT, but the relation of specific CRRT attributes to the risk and degree of platelet loss. 1,10,12 Missing from this literature is the pathology in which thrombocytopenia develops. Oever et al suggested a trapping phenomenon in the extracorporeal circuit resulting in activation of the platelets and sequestration.…”

“…Unlike past data there was no correlation identified between circuit anticoagulation or circuit flow rate and the rate of thrombocytopenia. 10,12 We did however evaluate the impact of this platelet decline on the care of patients. Patients experiencing a decline in platelets had a substantially greater rate of being tested and treated for HIT, as well as holding anticoagulation.…”

Transport Characteristics of Asymmetric Cellulose Triacetate Hemodialysis Membranes

“…Recent proteomic analyses of the material eluted from the membrane after clinical hemodialysis show that the proteins found on cellulose triacetate membranes are dominated by the more abundant plasma proteins like albumin and lipoproteins compared to the high levels of fibrinogen and ficolin-2 on polysulfone membranes [5]. These differences in plasma protein adsorption are likely associated with the lower level of platelet loss seen with cellulose triacetate membranes compared to polysulfone [6,7]. …”