Heparin‐grafted dialysis membrane allows minimal systemic anticoagulation in regular hemodialysis patients: A prospective proof‐of‐concept study

Kessler, Michèle; Gangemi, Concetta; Martones, Alberto Gutierrez; Lacombe, Jean‐Louis; Krier‐Coudert, Marie‐Jeanne; Galland, Roula; Kielstein, Jan T.; Moureau, Frédérique; Loughraieb, Nathalie

doi:10.1111/j.1542-4758.2012.00733.x

Cited by 32 publications

(29 citation statements)

References 38 publications

(56 reference statements)

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“…The use of heparin pregrafted membranes increases the rate of successful heparin-free intermittent hemodialysis sessions in high bleeding risk patients [60] and allows for a reduction of systemic heparin dosing, without compromising the dialysis session [61]. However, none of the published studies assessing the oXiris ® membrane has specifically evaluated its antithrombogenic properties in the setting of acute septic patients and CRRT.…”

Section: Antithrombogenic Treatmentmentioning

confidence: 99%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

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Section: Antithrombogenic Treatmentmentioning

confidence: 99%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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“…In vitro and in vivo data requested for CE marking (conformity with European Medical Device Directive 93/42/ EEC) have shown the stability of heparin grafting with absolutely no release (Supplementary Appendix online). In a study conducted in 45 regular dialysis patients, Kessler et al 15 found that the systemic heparin dose could be reduced by 45±13% without any coagulation issues. In addition, Sanchez-Canel et al 16 have observed, in six patients treated with postdilution hemodiafiltration, no increase in complete clotting event frequency with HGM without systemic anticoagulation, compared with polysulfone membrane and standard anticoagulation with nadroparin.…”

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confidence: 99%

Results of the HepZero study comparing heparin-grafted membrane and standard care show that heparin-grafted dialyzer is safe and easy to use for heparin-free dialysis

Laville

Dorval

Ros

et al. 2014

Kidney International

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Results of the HepZero study comparing heparin-grafted membrane and standard care show that heparin-grafted dialyzer is safe and easy to use for heparin-free dialysis Gambro-Hospal, Meyzieu, FranceHeparin is used to prevent clotting during hemodialysis, but heparin-free hemodialysis is sometimes needed to decrease the risk of bleeding. The HepZero study is a randomized, multicenter international controlled open-label trial comparing no-heparin hemodialysis strategies designed to assess non-inferiority of a heparin grafted dialyzer (NCT01318486). A total of 251 maintenance hemodialysis patients at increased risk of hemorrhage were randomly allocated for up to three heparin-free hemodialysis sessions using a heparin-grafted dialyzer or the center standardof-care consisting of regular saline flushes or pre-dilution. The first heparin-free hemodialysis session was considered successful when there was neither complete occlusion of air traps or dialyzer, nor additional saline flushes, changes of dialyzer or bloodlines, or premature termination. The current standard-of-care resulted in high failure rates (50%). The success rate in the heparin-grafted membrane arm was significantly higher than in the control group (68.5% versus 50.4%), which was consistent for both standardof-care modalities. The absolute difference between the heparin-grafted membrane and the controls was 18.2%, with a lower bound of the 90% confidence interval equal to plus 7.9%. The hypothesis of the non-inferiority at the minus 15% level was accepted, although superiority at the plus 15% level was not reached. Thus, use of a heparin-grafted membrane is a safe, helpful, and easy-to-use method for heparin-free hemodialysis in patients at increased risk of hemorrhage.

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“…A significant reduction in heparin dose and anti-Xa activity at the end of HD sessions was possible in stable HD patients using heparin-grafted membranes [22]. This method could be used to reduce the risk of bleeding and other adverse heparin events.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the AN69ST Membrane versus Citrate-Enriched Dialysate on Clotting Events during Hemodialysis without Systemic Anticoagulation

Nseir

Rachas²,

Elias³

et al. 2017

Blood Purif

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Background: The optimal management of anticoagulation in hemodialyzed patients with a high risk of bleeding is controversial. Methods: We compared premature termination of dialysis caused by clotting events between AN69ST membranes (G1) and 0.8 mmol/L citrate-enriched dialysate (G2). The number of sessions that had increased venous pressure (VP) and variations in urea-reduction ratio (URR) were analyzed. Results: Six hundred and two sessions were analyzed in 259 patients: 22.4% had sessions that ended prematurely (25% in G1 and 19.1% in G2, p = ns, OR 0.60 [0.34-1.08], p = 0.08). The increase in VP was lower in G2 (23 vs. 70, p < 0.001). URR was higher in G2 (0.56 vs. 0.60, p < 0.001). Conclusion: Clotting events that led to the termination of dialysis were comparable in the 2 groups. However, UUR was better in G2, and the number of patients with increased VP in the sessions was lower in G2. Short Summary: Our study compared the effects of the AN69ST membrane and citrate-enriched dialysate on clotting events during the dialysis of 259 patients with a high risk of bleeding. URR was significantly better and fewer cases of increased VP occurred in the citrate group compared to the AN69 ST group. No significant difference was observed regarding the need to prematurely terminate a dialysis session.

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Heparin‐grafted dialysis membrane allows minimal systemic anticoagulation in regular hemodialysis patients: A prospective proof‐of‐concept study

Cited by 32 publications

References 38 publications

Extracorporeal Blood Purification Therapies for Sepsis

Extracorporeal Blood Purification Therapies for Sepsis

Results of the HepZero study comparing heparin-grafted membrane and standard care show that heparin-grafted dialyzer is safe and easy to use for heparin-free dialysis

Comparison of the AN69ST Membrane versus Citrate-Enriched Dialysate on Clotting Events during Hemodialysis without Systemic Anticoagulation

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