Current Practices in Acute Blood Purification Therapy in Japan and Topics for Further Study

Sadahiro, Tomohito; Yuzawa, Hiroko; Kimura, Tomonori; Oguchi, Moe; Morito, Tomohiro; Mizushima, Shohei; Hirose, Yousuke

doi:10.1159/000485724

Cited by 11 publications

(8 citation statements)

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“…Nafamostat mesylate, a synthetic serine protease inhibitor, is a short-acting anticoagulant ( 28 ), and is also used during hemodialysis to prevent proteolysis of fibrinogen into fibrin ( 29 ). It is a slow, tight-binding substrate that traps the target protein in the acyl-enzyme intermediate form and inhibits enzyme activity ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

Measuring the Concentration of Serum Syndecan-1 to Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

et al. 2021

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Glycocalyx is present on the surface of healthy endothelium, and the concentration of serum syndecan-1 can serve as an injury marker. This study aimed to assess endothelial injury using serum syndecan-1 as a marker of endothelial glycocalyx injury in patients who underwent hemodialysis. In this single-center, retrospective, observational study, 145 patients who underwent hemodialysis at the Gifu University Hospital between March 2017 and December 2019 were enrolled. The median dialysis period and time were 63 months and 3.7 h, respectively. The serum syndecan-1 concentration significantly increased from 124.6 ± 107.8 ng/ml before hemodialysis to 229.0 ± 138.1 ng/ml after hemodialysis (P < 0.001). Treatment with anticoagulant nafamostat mesylate inhibited hemodialysis-induced increase in the levels of serum syndecan-1 in comparison to unfractionated heparin. Dialysis time and the change in the syndecan-1 concentration were positively correlated. Conversely, the amount of body fluid removed and the changes in the syndecan-1 concentration were not significantly correlated. The reduction in the amount of body fluid removed and dialysis time inhibited the change in the syndecan-1 levels before and after hemodialysis. In conclusion, quantitative assessment of the endothelial glycocalyx injury during hemodialysis can be performed by measuring the serum syndecan-1 concentration, which may aid in the selection of appropriate anticoagulants, reduction of hemodialysis time, and the amount of body fluid removed.

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Section: Discussionmentioning

confidence: 99%

Measuring the Concentration of Serum Syndecan-1 to Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

et al. 2021

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“…NM is suitable for dialysis because of its short half-life of 5-8 min and small molecular weight of 539.6 [14,17]. Due to these properties, NM has been widely used as an anticoagulant with a low risk of causing hemorrhagic complications for CRRT in Japan [6]. According to the 2013 surveillance by the Japan Society for Blood Purification in Critical Care (JSBPCC), anticoagulants used for HDF in ICUs at 43 institutions in Japan were NM (84.3%), heparin (11.5%), LMWH (2.4%), and others (1.8%) [2], which indicates that NM is the predominantly used anticoagulant in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…When CRRT is performed, administration of anticoagulants is necessary for achieving certain levels of circuit and filter lifetimes. As for anticoagulants, nafamostat mesylate (NM), which is considered less likely to cause hemorrhagic complications, has been covered by the National Health Insurance scheme and is widely used in Japan [6]. The dose of this anticoagulant is predefined and fixed or it is determined to maintain activated partial thromboplastin time (APTT) or activated clotting time (ACT), etc.…”

Section: Introductionmentioning

confidence: 99%

Filter lifetimes of different hemodiafiltration membrane materials in dogs: reevaluation of the optimal anticoagulant dosage

et al. 2021

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Background In continuous renal replacement therapy (CRRT), administration of anticoagulants is necessary for achieving a certain level of filter lifetime. Generally, anticoagulant doses are controlled to keep activated partial thromboplastin time and other indicators within a certain target range, regardless of the membrane materials used for the filter. However, in actual clinical practice, the filter lifetime varies significantly depending on the membrane material used. The objective of this study was to demonstrate that the minimum anticoagulant dose necessary for prolonging the filter lifetime while reducing the risk of hemorrhagic complications varies depending on the type of membrane. Methods In three beagles, hemodiafiltration was performed with hemofilters using polysulfone (PS), polymethylmethacrylate (PMMA), and AN69ST membranes separately. The minimum dose of nafamostat mesylate (NM) that would allow for 6 h of hemodiafiltration (required dose) was investigated for each membrane material. Results The NM doses required for 6 h of hemodiafiltration were 2 mg/kg/h for the PS membrane, 6 mg/kg/h for the PMMA membrane, and 6 mg/kg/h for the AN69ST membrane. Conclusion For hemodiafiltration performed in beagles, the required NM dose varied for each filter membrane material. Using the optimal anticoagulant dose for each membrane material would allow for safer CRRT performance.

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“…Nafamostat mesylate, a synthetic serine protease inhibitor, is a short-acting anticoagulant 28 , and is also used during hemodialysis to prevent proteolysis of brinogen into brin 29 . It is a slow, tight-binding substrate that traps the target protein in the acyl-enzyme intermediate form, and inhibits enzyme activity 30,31 .…”

Section: Discussionmentioning

confidence: 99%

Measuring The Concentration of Serum Syndecan-1 To Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

Kusuzawa

Suzuki

Okada

et al. 2021

Preprint

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Glycocalyx is present on the surface of healthy endothelium, and the concentration of serum syndecan-1 can serve as an injury marker. This study aimed to evaluate the hemodialysis-associated changes in the serum syndecan-1 concentration. This was a single-center, retrospective, observational study. Between March 2017 and December 2019, 145 patients who underwent hemodialysis at the Gifu University Hospital were enrolled. The median dialysis period and dialysis time were 63 months and 3.7 hours, respectively. The serum syndecan-1 concentration increased from 124.6 ± 107.8 ng/mL before hemodialysis to 229.0 ± 138.1 ng/mL after hemolysis (P < 0.001). Treatment with anticoagulant nafamostat mesylate inhibited hemodialysis-induced increase in the levels of serum syndecan-1 in comparison to unfractionated heparin. Dialysis time and the change in concentration of syndecan-1 were positively correlated, whereas the amount of body fluid removed and changes in the concentration of syndecan-1 were not correlated. The reduction in amount of body fluid removed and dialysis time inhibited the change in of syndecan-1 levels before and after hemodialysis. In conclusion, quantitative assessment of the endothelial glycocalyx injury during hemodialysis can be done by measuring the concentration of serum syndecan-1 which may aid in the selection of appropriate anticoagulants, hemodialysis time, and the amount of body fluid removed.

show abstract

Current Practices in Acute Blood Purification Therapy in Japan and Topics for Further Study

Cited by 11 publications

References 0 publications

Measuring the Concentration of Serum Syndecan-1 to Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

Measuring the Concentration of Serum Syndecan-1 to Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

Filter lifetimes of different hemodiafiltration membrane materials in dogs: reevaluation of the optimal anticoagulant dosage

Measuring The Concentration of Serum Syndecan-1 To Assess Vascular Endothelial Glycocalyx Injury During Hemodialysis

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