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

Nseir, Vanessa; Rachas, Antoine; Elias, Michelle; François, H.; Obada, Erika Nnang; Lorenzo, Hans K.; Charpentier, B; Dürrbach, Antoine; Beaudreuil, Séverine

doi:10.1159/000456532

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…This likely would not have influenced the results since (i) the same dialysate was used for both modalities and (ii) certain other studies have demonstrated that citrate-containing dialysate does not significantly reduce clotting in the extracorporeal circuit. [20][21][22] In addition to the clotting issue, predilution HDF may provide some benefit over HD by increasing the clearance of the middle molecules; however, the convective flux in our study was probably not sufficiently high to achieve a significant effect and, moreover, the positive effect of increased clearance may be blunted by the premature clotting. As shown by the ionic dialysance, the diffusive epuration of the small solutes was comparable between the two techniques.…”

Section: Discussionmentioning

confidence: 60%

“…In the present study, we used a dialysate containing citrate at very low concentration. This likely would not have influenced the results since (i) the same dialysate was used for both modalities and (ii) certain other studies have demonstrated that citrate‐containing dialysate does not significantly reduce clotting in the extracorporeal circuit …”

Section: Discussionmentioning

confidence: 99%

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Hemodialysis without anticoagulation: Less clotting in conventional hemodialysis than in predilution hemodiafiltration

Krummel

Cellot

Thiéry³

et al. 2019

Hemodialysis International

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Introduction Hemodialysis patients with contraindication to systemic anticoagulation require a heparin‐free hemodialysis technique. Among several alternatives to heparin, predilution hemodiafiltration (HDF) is often used, albeit without any confirmation of its effectiveness. Methods Patients hospitalized in a nephrology ICU and hemodialysed for stage 5 CKD or AKI and with contraindication to systemic anticoagulation were randomized to either standard HD with a polysulfone membrane, or to predilution HDF with the same membrane. Coagulation activation was evaluated clinically by the need for premature termination and by the measurement of D‐dimers. Findings Two hundred dialysis sessions were performed in 155 patients. Survival curves showed better circuit survival in HD (P = 0.046). In HD, 12% of sessions were interrupted for coagulation versus 23% in predilution HDF (P = 0.04). Discussion Predilution HDF was associated with more premature clotting than conventional HD without improvement in dialysis duration or performance epuration indices. When aiming for a 4‐hour duration session, conventional heparin‐free hemodialysis can be safely proposed in most patients with high bleeding risk.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Hemodialysis without anticoagulation: Less clotting in conventional hemodialysis than in predilution hemodiafiltration

Krummel

Cellot

Thiéry³

et al. 2019

Hemodialysis International

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“…125,126 The comparison between AN69ST membrane and citrate-enriched dialysate did not assess differences on clotting events and dialysis session premature suspension, in patients at high risk of bleeding. 127 However, a retrospective analysis of 309 HD sessions, performed without systemic anticoagulation, due to high risk of bleeding, with a contemporary use of heparin-…”

Section: Anti Coag Ul Ati On Sys Temmentioning

confidence: 99%

“…However, when compared to regional citrate coagulation, the heparinized filter was less efficient, in terms of clotting of the extracorporeal circuit and dialysis efficacy, as revealed by a prospective and controlled trial in which heparin‐grafted polyacrylonitrile (AN69ST) dialyzer, in the absence of systemic anticoagulation, was complicated by high incidence of circuit coagulation 125,126 . The comparison between AN69ST membrane and citrate‐enriched dialysate did not assess differences on clotting events and dialysis session premature suspension, in patients at high risk of bleeding 127 . However, a retrospective analysis of 309 HD sessions, performed without systemic anticoagulation, due to high risk of bleeding, with a contemporary use of heparin‐grafted AN69ST dialyzer membrane and citrate‐enriched dialysate, demonstrated successful data, with completed sessions for treatment times of ≥4 hours achieved in 81% of patients 128 …”

Section: Anticoagulation Systemmentioning

confidence: 99%

Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy

Monardo

Lacquaniti

Campo

et al. 2021

Seminars in Dialysis

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Morbidity and mortality marginally decreased over the last three decades in hemodialyzed (HD) patients, despite the introduction of multiple pharmacological and technological advancement. 1 Several randomized controlled studies failed to demonstrate the superiority of one procedure, schedule, or pharmacological interventions on survival and, consequently, weak level of recommendations has been revealed by best practice guidelines. [2][3][4][5] These negative results are closely related to the complexity of uremia, characterized by several metabolic disorders, as well as hyperparathyroidism, metabolic acidosis, Lcarnitine deficiency, and risk factors, influencing all-cause mortality. [6][7][8] General dialysis-dependent population is in fact elderly and affected by multiple co-morbid conditions, while hemodialysis (HD) represents just one component of the overall outcome-based risk profile. In particular, diabetes as well as obesity, due to their increasing incidence, are directly involved in kidney disease onset and progression. 9 Moreover, global patient heterogeneity, related to genetic, environmental, and demographic factors, needs to be evaluated as a risk factor for renal disease. Large-scale meta-analyses of genome-wide association studies have identified a number of loci significantly associated with systolic and/or diastolic blood pressure, apolipoproteins, or polymorphisms of vitamin D receptor, closely involved in the development of kidney disease. [10][11][12] Other obstacle to apply personalized dialysis is the lack of resources in the current sanitary systems, considering that, due to the combination of high costs and widespread need, renal replacement therapy is one of the most expensive treatments. 13,14 The actual costs of dialysis are not uniformly defined, with significant differences between highly resourced countries, where the most important item is the cost of nursing and medical care, and emerging countries, where the cost of dialysis supplies represents the most relevant item. 15 Moreover, ecologic implication is closely related with each HD session, analyzing water, energy, and waste

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“…In China, there are three common anticoagulation means clinically, including unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and 'no heparin,' where LMWH is the prioritized option in maintenance HD. However, CKD patients already have an increased risk of excess bleeding, such as platelet dysfunction caused by uremia (2,3), let alone the potentially fatal heparin-induced thrombocytopenia type II and 'no heparin'-induced consumption of platelet when receiving dialysis (4,5). Regional citrate anticoagulation has been tested on dialysis, but it might lead to potentially disastrous complications, such as citrate accumulation presenting metabolic acidosis, hypernatremia, and citrate net overload presenting metabolic alkalosis (6).…”

Section: Introductionmentioning

confidence: 99%

The effects of citrate dialysate in hemodialysis on polymorphonuclear elastase interaction with tissue factor and its inhibitor

Sun

Han

et al. 2019

Ann. Transl. Med.

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Background: This study aimed to investigate whether hemodialysis (HD) affects tissue factor (TF), tissue factor pathway inhibitor (TFPI), and polymorphonuclear elastase (PMNE) in endstage renal disease (ESRD) patients when eliminating the effects of heparin. Also, to explore the interaction of TF, TFPI, and PMNE throughout a single HD session. Methods: We enrolled 57 ESRD patients who had undergone hemodialysis for >3 months as an experimental group. Plasma levels of TF, TFPI and PMNE were measured by ELISA in 24 ERSD patients on intermittent HD using low-molecular-weight heparin (LMWH) as anticoagulation (LMWH group) and 33 ESRD patients using citrate as anticoagulation (citrate group) at the start and at 1, 2 and 5 h of the HD session. Meanwhile,28 ESRD patients not on dialysis were enrolled as a control group and fasting venous blood samples were taken in the morning. Results: Compared with the control group, the plasma TFPI levels of the LMWH group and the citrate group were significantly higher (P=0.000, P=0.002, respectively) under baseline conditions as well as the plasma PMNE levels (P=0.001, P=0.02,respectively), whereas TF showed no difference (P=0.186). During HD with citrate, plasma TFPI decreased slightly (P=0.012) and PMNE increased significantly (P=0.008) at 1 h. The plasma TFPI levels of the citrate group correlate with PMNE at 2 and 5 h (P=0.001, P=0.008, respectively). Conclusions: ESRD patients on HD have significantly higher TFPI and PMNE levels compared to patients not on HD under baseline conditions, while TF levels were similar between the three groups. TFPI and PMNE are differently regulated, but the plasma levels correlated during HD in the citrate group. It might be possible that PMNE plays a role in anticoagulative activity through TFPI.

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

Cited by 4 publications

References 29 publications

Hemodialysis without anticoagulation: Less clotting in conventional hemodialysis than in predilution hemodiafiltration

Hemodialysis without anticoagulation: Less clotting in conventional hemodialysis than in predilution hemodiafiltration

Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy

The effects of citrate dialysate in hemodialysis on polymorphonuclear elastase interaction with tissue factor and its inhibitor

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