Using AN69 ST membrane: A dialysis centre experience

Maheut, Hervé; Lacour, F.

doi:10.1093/ndt/16.7.1519

Cited by 15 publications

(8 citation statements)

References 3 publications

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“…This filter has been modified to avoid bradykinin release and has previously been reported safe for use in ACEI-treated patients [2,6,7]. This study demonstrates that such reactions may also appear with the AN69 ST filter.…”

Section: Discussionmentioning

confidence: 70%

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A Heparin-Coated Dialysis Filter (AN69 ST) Does Not Reduce Clotting during Hemodialysis when Compared to a Conventional Polysulfone Filter (F×8)

Sagedal

Witczak²,

Osnes³

et al. 2011

Blood Purif

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Background: We investigated whether the heparin-coated AN69 ST hemodialysis (HD) filter induced less hypercoagulability during HD than a conventional polysulfone filter (F×8). Methods: In a crossover design, 11 patients were treated alternately with AN69 ST and F×8 filters (45 sessions). All filters were primed with unfractionated heparin (UFH) and unadsorbed UFH was removed by saline flushing. Half the conventional dalteparin dose was given as a bolus dose at the start of HD. Clotting was evaluated hourly in the venous air trap. Prothrombin fragments 1 and 2 (PF1 + 2), antithrombin (AT), β-TG and anti-FXa activity were repeatedly measured. Results: One patient treated with enalapril had two repeated adverse reactions to the AN69 ST filter and was excluded from the study. Use of the AN69 ST filter did not decrease the mean clot score or PF1 + 2, but decreased β-TG compared to the F×8 filter. Conclusion: The heparin-coated AN69 ST filter did not induce less coagulation when compared to the F×8 filter.

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Section: Discussionmentioning

confidence: 70%

“…The hypersensitivity reaction is associated with bradykinin release [6]. A reduction in kallikrein activity and bradykinin concentration has been reported with modification of the AN69 filter resulting in the less electronegative AN69 ST filter, which is reported to be safe even in ACEI-treated patients [2,7]. …”

Section: Introductionmentioning

confidence: 99%

A Heparin-Coated Dialysis Filter (AN69 ST) Does Not Reduce Clotting during Hemodialysis when Compared to a Conventional Polysulfone Filter (F×8)

Sagedal

Witczak²,

Osnes³

et al. 2011

Blood Purif

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“…Use of the original AN69 filter in RRT was historically associated with increased hypersensitivity reactions due to bradykinin release [21–23]. Coating the AN69 membrane with PEI did not alter its biocompatibility but reductions in the kallikrein activity and bradykinin concentration were observed, and no hypersensitivity reactions were reported when AN69 membranes were changed to AN69ST membranes [24–26].…”

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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“…In a retrospective and uncontrolled study, the use of alkaline rinsing solution by keeping the pH value above 7.5 prevented the development of hypersensibility reactions due to inhibition of kallikrein synthesis (35). Reduction of surface electronegativity by coating the AN69 membrane with a polycationic saline solution avoided the generation of bradykinin (36). Nevertheless, an anaphylactoid reaction has been reported in a patient during dialysis with a surface‐treated AN69 membrane who received a single dose of captopril (37).…”

Section: Ace Inhibitorsmentioning

confidence: 99%

HYPERTENSION IN HEMODIALYSIS PATIENTS: Drug Therapy for Hypertension in Hemodialysis Patients

Hörl

2004

Seminars in Dialysis

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The majority of end-stage renal disease (ESRD) patients are hypertensive. Drug therapy for hypertension in hemodialysis (HD) patients includes all classes of antihypertensive drugs, with the sole exception of diuretics. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers may decrease morbidity and mortality by reducing the mean arterial pressure (MAP), aortic pulse wave velocity, and aortic systolic pressure augmentation, as well as left ventricular hypertrophy (LVH) and probably reduction of C-reactive protein (CRP) and oxidant stress. Potential risk factors include hyperkalemia, anaphylactoid reaction with AN69 membranes (particularly ACE inhibitors), and aggravation of renal anemia. beta-blockers decrease not only mortality, blood pressure (BP), and ventricular arrhythmias, but also improve left ventricular function in ESRD patients. Nonselective beta-blockers can cause an increase in serum potassium (particularly during fasting or exercise). Lisinopril and atenolol have a predominant renal excretion and therefore a prolonged half life in ESRD patients. Thus thrice-weekly supervised administration of these drugs after HD can enhance BP control. The use of calcium channel blockers is also associated with lower total and cardiovascular-specific mortality in HD patients. Minoxidil is a very potent vasodilator that is generally reserved for dialysis patients with severe hypertension. Hypertensive dialysis patients who are noncompliant with their medications may benefit from transdermal clonidine therapy once a week. The majority of dialysis patients need a combination of several antihypertensive drugs for adequate BP control.

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Using AN69 ST membrane: A dialysis centre experience

Cited by 15 publications

References 3 publications

A Heparin-Coated Dialysis Filter (AN69 ST) Does Not Reduce Clotting during Hemodialysis when Compared to a Conventional Polysulfone Filter (F×8)

A Heparin-Coated Dialysis Filter (AN69 ST) Does Not Reduce Clotting during Hemodialysis when Compared to a Conventional Polysulfone Filter (F×8)

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

HYPERTENSION IN HEMODIALYSIS PATIENTS: Drug Therapy for Hypertension in Hemodialysis Patients

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