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, Maurice; Dorval, Marc; Ros, Joan Fort; Fay, Renaud; Cridlig, Joëlle; Nortier, Joëlle; Juillard, Laurent; Dębska-Ślizień, Alicja; Lorente, Loreto Fernández; Thibaudin, Damien; Franssen, Casper F. M.; Schulz, Michael; Moureau, Frédérique; Loughraieb, Nathalie; Rossignol, Patrick

doi:10.1038/ki.2014.225

Cited by 76 publications

(71 citation statements)

References 23 publications

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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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“…By rinsing in unfractionated heparin saline, the membrane is primed with a heparin layer, which reduces membrane thrombogenicity [7, 8]. Previous studies have reported successful heparin-free extracorporeal circulation with the AN69ST filter for a maximum 6 h. However in the HepZero study [10, 12] reported by Laville M et al, the risk of premature clotting during 4-h hemodialysis reached more than 30% by use of a heparin-coated dialyzer, although it resulted in a higher success rate when compared with standard heparin-free hemodialysis (68.5% vs. 50.4%, respectively). Similarly in the present prospective, randomized self-controlled study, PI-RRT was completed for a duration of 543.1 ± 119.0 min in only 51.7% of patients using an AN69ST hemofilter.…”

Section: Discussionmentioning

confidence: 99%

Polyethyleneimine-treated polyacrylonitrile membrane hemofilter for critically ill patients receiving anticoagulant-free prolonged intermittent renal replacement therapy: a single-center, prospective, self-controlled pilot study

Jin

Liu

2017

BMC Nephrol

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BackgroundCritically ill patients requiring renal replacement therapy (RRT) are at risk of disease-related bleeding. Systemic heparinization should be avoided. AN69ST, a polyethyleneimine-treated polyacrylonitrile (AN69) membrane hemofilter, can be primed with heparin, improving its local anticoagulative activity. Prolonged intermittent RRT (PI-RRT) is of shorter duration and cheaper, considered as an alternative to continuous RRT. This study was performed to compare the success rate of anticoagulant-free PI-RRT using AN69ST versus AN69 membrane hemofilter. We also evaluated risk factors for filter clotting.MethodsThis crossover, double-blind, randomized study included patients requiring PI-RRT but at high bleeding risk treated with AN69ST and AN69 hemo filters. The success rate of RRT, filter lifespan and severity of filter clotting were compared between the hemo filters. Factors associated with the filter clotting risk were analyzed with a Cox proportional hazards model.ResultsThis study included 60 patients (mean age, 68.1 ± 15.8 years). Thirty-three (55.0%) patients were in the intensive care unit, 34 (56.8%) had disease-related thrombocytopenia, and 14 (23.3%) had local hemorrhagic diseases. The success rate of PI-RRT with the AN69ST and AN69 hemofilter was 51.7% and 50.9%, respectively (P > 0.05). The mean PI-RRT duration was 543.1 ± 119.0 min in the completed sessions and 387.3 ± 140.8 min in the prematurely terminated sessions, without significant difference between AN69ST and AN69 hemofilters. Cox regression analysis showed that age (odds ratio [OR], 1.023 per year), platelet count (OR, 1.07 per 10 × 109/L), hemoglobin concentration (OR, 1.035 per 1 g/L), and activated partial thromboplastin time (aPTT; OR, 0.973 per second) were associated with a hemofilter clotting risk. The AN69ST hemofilter lifespan was significantly prolonged averaging an extra 251.7 min in patients with an aPTT of <35.3 s, hemoglobin concentration of >83 g/L and platelet count of <70 × 109/L.ConclusionsAnticoagulant-free PI-RRT by a heparin-primed AN69ST hemofilter reached a 51.7% success rate. The risk of premature clotting of the extracorporeal circuit remains unsatisfactory. For select patients at high risk of bleeding, the heparin-primed AN69ST hemofilter may be more appropriate for anticoagulation-free PI-RRT.Trial registration https://www.clinicaltrials.gov; study number: NCT02355873. Release Date 01/21/2015

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“…For patients with contraindications to systemic anticoagulation, options include heparin-free HD (regular saline flushing of the circuit), regional citrate anticoagulation 2 or use of dialysers with heparin-coated membranes. 3 …”

Section: The Dialysis System: Technical Considerationsmentioning

confidence: 97%

Haemodialysis

Wong¹,

Farrington²

2015

Medicine

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The haemodialysis population continues to increase and is becoming more elderly and dependent. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of dialysis adequacy, based on urea clearance, need to be broadened to encompass parameters such as b 2 -microglobulin clearance, salt and water balance, and phosphate control. Haemodiafiltration provides improved b 2 -microglobulin clearance over haemodialysis, and may improve survival. There is a trend towards individualizing haemodialysis dose to the needs of the patient. Patients with significant residual kidney function may require less dialysis. For others without residual function, more frequent treatments may be necessary to adequately control uraemia and volume status, and to improve survival. Home-based treatment can facilitate more frequent treatments for a proportion of patients, although centre-based therapy remains the default for the majority.

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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

Cited by 76 publications

References 23 publications

Extracorporeal Blood Purification Therapies for Sepsis

Extracorporeal Blood Purification Therapies for Sepsis

Polyethyleneimine-treated polyacrylonitrile membrane hemofilter for critically ill patients receiving anticoagulant-free prolonged intermittent renal replacement therapy: a single-center, prospective, self-controlled pilot study

Haemodialysis

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