Comparative analysis of procoagulatory activity of haemodialysis, haemofiltration and haemodiafiltration with a polysulfone membrane (APS) and with different modes of enoxaparin anticoagulation

Klingel, Reinhard; Schaefer, Michael; Schwarting, Andreas; Himmelsbach, Frido; Altes, Ulrich; Uhlenbusch-Körwer, Ingrid; Häfner, Gerd

doi:10.1093/ndt/gfg459

Cited by 83 publications

(67 citation statements)

References 13 publications

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“…However, several other systems become altered during bloodmembrane interaction. Among them are the coagulation system and imbalances of the oxidative and anti-oxidative system (Krieter et al, 2007;Klingel et al, 2004). A slightly decrease in outlet leukocyte counts was observed for the three dialyzers, and significant difference was observed among them, as shown in Figure 11 For urea; For creatinine; For  2 -microglobulin white blood cells was caused by complement activation, thus similar results were obtained in the changes of complement factor C3 and complement C4 during the hemodialysis process.…”

Section: Biocompatibilitysupporting

confidence: 63%

“…In terms of complement activation and changes in leukocyte count, the new dialyzer is also comparable with the other biocompatible dialyzers. Besides the thrombogenicity, complement activation, and WBC count changes, other issues must be considered when evaluating bio(in)compatibility (Krieter et al, 2007;Klingel et al, 2004) One further aspect merits consideration is that the PES membrane dialyzer series exhibits a higher permeability and thus, cytokine-inducing substances, possibly present in the dialysis fluid, might gain access to the blood stream through internal filtration (backfiltration). Therefore, investigations on the pyrogen permeability of PES membranes have been performed to the studies on the inflammatory response of the membrane.…”

Section: Biocompatibilitymentioning

confidence: 99%

See 1 more Smart Citation

Polyethersulfone Hollow Fiber Membranes for Hemodialysis

Su¹,

Sun²,

Zhao³

2011

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice

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Section: Biocompatibilitysupporting

confidence: 63%

Section: Biocompatibilitymentioning

confidence: 99%

Polyethersulfone Hollow Fiber Membranes for Hemodialysis

Su¹,

Sun²,

Zhao³

2011

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice

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“…Blood samples to determine anti-Xa activity and TAT were taken from the arterial and venous blood line before the enoxaparin bolus, after 15 min, at 2 h, and at the end of HD. Median and mean duration of dialysis sessions was 4 h. Anti-Xa activity was determined with Coatest ® LMW Heparin/Heparin (Chromogenix, Monza, Italy) and TAT with the Enzygnost ® TAT micro (Behringwerke AG, Marburg, Germany) following the manufacturer's instructions and as otherwise described [9,10].…”

Section: Molecular Characterization Of Enoxaparin Anticoagulationmentioning

confidence: 99%

Safety and Efficacy of Single Bolus Anticoagulation with Enoxaparin for Chronic Hemodialysis. Results of an Open-Label Post-Certification Study

Klingel

Schwarting

Lotz

et al. 2004

Kidney Blood Press Res

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Background: Low-molecular-weight heparin (LMWH) is supposed to be advantageous compared to unfractionated heparin for chronic hemodialysis (HD) with respect to lipid and bone metabolism, polymorphonuclear cell stimulation, induction of antibody-mediated thrombocytopenia, and aldosterone suppression. Due to longer biological half-life, LMWH offers the possibility of single bolus administration. Methods: To assess safety and efficacy of single bolus anticoagulation with enoxaparin for chronic HD, 781 stable HD patients from 79 German dialysis centers (mean age 62 years; 31% ESRD due to diabetes mellitus) were monitored by clinical and laboratory parameters for 32 weeks. Additionally, in a single dialysis center, 22 chronic HD patients were investigated by molecular markers of coagulation during chronic HD under conditions of single bolus or continuous anticoagulation regimens. Anti-Xa activity and the thrombin- antithrombin-III complex (TAT) were determined before the enoxaparin bolus, after 15 min, 2 h, and at the end of HD in venous and arterial blood lines. Results: Chronic HD was performed in 24,117 HD treatments with enoxaparin at a median dose of 70.1 IU/kg (5,000 IU median total dose) for single bolus anticoagulation. In 83.0% of HD treatments, enoxaparin was given as single bolus. In 98.3% of patients no adverse event was reported. No drug-related severe adverse event occurred. Significant clotting problems were observed in only 0.3% of HD treatments with single bolus anticoagulation. As assessed in 257 HD treatments, essentially identical anti-Xa levels were detected at the end of HD with single bolus (50 IU/kg) or continuous (mean total dose 43 IU/kg) anticoagulation regimens. Bolus anticoagulation resulted in higher TAT generation at the end of HD. However, this was not associated with increased macroscopic clot formation. Conclusion: Single bolus anticoagulation with enoxaparin was safe and effective for chronic HD. For a duration of 4 h HD, a median dose of 70 IU/kg can be recommended for regular use, which is in accordance with the manufacturer’s instructions for use of enoxaparin recommending a range of 50–100 IU/kg.

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“…This technique usually requires higher or at least identical doses of heparin [14]. No study to date has evaluated the use of CitA-D in postdilution OL-HDF.…”

Section: Introductionmentioning

confidence: 99%

Safe Use of Citric Acid-Based Dialysate and Heparin Removal in Postdilution Online Hemodiafiltration

Aniort¹,

Petitclerc²,

Créput³

2012

Blood Purif

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Background: Anticoagulation of the blood circuit with heparin is essential for hemodialysis, but exposes patients to several risks (bleeding, thrombocytopenia, etc.). The use of citric acid-based dialysate (CitA-D) allows the reduction of heparin in conventional hemodialysis. We evaluated the feasibility of using CitA-D in postdilution online hemodiafiltration (OL-HDF) and of removing heparin. Methods: We prospectively compared chlorhydric acid-based dialysate with CitA-D in 10 patients treated by OL-HDF. First, we reduced heparin by half the dose and then we totally removed anticoagulation. Results: For all 120 sessions using heparin-free CitA-D, only one clotting episode related to an arteriovenous fistula stenosis was observed. No adverse clinical effect was observed. (Kt/V)_sp, predialytic serum bicarbonate, calcium, phosphate, parathroid hormone, and β₂-microglobulin remained the same in all cases. Conclusion: Our data suggest that the use of CitA-D in OL-HDF is safe and allows heparin removal in most patients.

show abstract

Comparative analysis of procoagulatory activity of haemodialysis, haemofiltration and haemodiafiltration with a polysulfone membrane (APS) and with different modes of enoxaparin anticoagulation

Cited by 83 publications

References 13 publications

Polyethersulfone Hollow Fiber Membranes for Hemodialysis

Polyethersulfone Hollow Fiber Membranes for Hemodialysis

Safety and Efficacy of Single Bolus Anticoagulation with Enoxaparin for Chronic Hemodialysis. Results of an Open-Label Post-Certification Study

Safe Use of Citric Acid-Based Dialysate and Heparin Removal in Postdilution Online Hemodiafiltration

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