Post‐Dilution Hemodiafiltration With a Heparin‐Grafted Polyacrylonitrile Membrane

Abstract

The aim of this multicenter, prospective study was to explore the possibility of carrying out routine sessions of post-dilution hemodiafiltration with a polyacrylonitrile membrane grafted with heparin (HeprAN) and reduced anticoagulation. Forty-four patients from eight centers were included in the study and treated by means of post-dilution on-line hemodiafiltration with automatic control of TMP, according to three different modalities tested consecutively: phase 1, polyethersulfone filter primed with heparinized saline and anticoagulated with continuous infusion of unfractionated heparin 1000/h; phase 2, HeprAN membrane filter primed with saline without heparin. Anticoagulation: a 1000-unit bolus of unfractionated heparin at the start of session followed by a second one at the end of the second dialysis hour; phase 3, same filter and priming procedure as in phase 2; anticoagulation with nadroparin calcium at the beginning of treatment. Partial or massive clotting of the dialyzer occurred in less than 1% of sessions in phase 1; 10% and 7% in phase 2; and 1% and 2% in phase 3. Clotting limited to the drip chambers was observed in 13%, 34% and 12%, respectively. The study of coagulation parameters showed a better profile when low-molecular weight heparin (LMWH) was used in association with HeprAN membrane, while the generation of TAT complexes did not differ from that observed with the standard anticoagulation modality used in phase 1. Our results suggest that the HeprAN membrane can be used safely in routine post-dilution hemodiafiltration with reduced doses of LMWH.

Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues

“…In THDFS, the unfractionated heparin dose was ∼10% higher in the HDF group when compared with HD patients [ 14 ]. A recent study, using heparin-coated membranes in ol-HDF, showed that the dose of LMWH could be reduced safely without an increased risk of clotting [ 36 ].…”

Hemodiálisis extendida frente a convencional o hemodiafiltración en línea. Estudio comparativo de necesidad de heparina y coagulación del sistema

“…De las tres membranas utilizadas en nuestro estudio, la PH fue la que menos heparina precisó, tan sólo 33 mg, misma situación que reflejan otras investigaciones [19][20][21] MCM: Membrana de corte medio de poliariletersulfona y polivinilpirrolidona, HBPM: heparina de bajo peso molecular; FAVn: fístula arteriovenosa nativa; CVCt: catéter venoso central tunelizado. †Test chi cuadrado o test exacto de Fisher para frecuencias inferiores a 5, en la comparación por tipo de dializador frente al resto de variables.…”

Recent Progress of Microfluidic Devices for Hemodialysis

“…Compared to cellulose membranes, organic synthetic membranes possess more physical‐chemical advantages in terms of pore size, hydraulic permeability and filtration capacity . Polysulfone (PS) and polyethersulfone (PES) membranes are two of the most classical synthetic membranes, which have been widely used in clinical hemodialysis due to their excellent filtering properties and biocompatibility, thermal stability, mechanical strength, and chemical inertness.…”