Does subjective assessment of dialyzer appearance reflect dialyzer performance in online hemodiafiltration?

Abstract

Introduction: In post-dilution online hemodiafiltration, a very thin balance subsists in preventing coagulation of the extracorporeal circuit (ECC) during treatment and bleeding in the patient, concerning dialyzer status and anticoagulation dose.The aim of this study was to assess whether there are clinical outcome differences between the visual aspect of the dialyzer's status in terms of clotted fibers at end of dialysis treatments, singlepool urea kinetic modeling (spKt/V) and substitution volume (SubsVol).Methods: It is a multicenter, descriptive-correlational study, involving 2829 patients during April 2016. Previous training was given to the Nursing staff to evaluate and classify both the dialyzer's and the venous chamber's appearance of the ECC venous line. Registration was performed at bedside immediately after the patient disconnection.Findings and discussion: Mean age was 68.96 years (SD = 13.75), 60.8% were men. The average hematocrit was 33.91% (SD = 3.45%). The average dry weight was 68.53 kg (SD = 13.27 kg). Mean unfractioned heparin (UFH) dose was 58.13 IU/kg. Only 32.4% of the patients had a clean dialyzer at the end of treatment. 19.4% of patients finished the treatment with more than 10% of clotted fibers. Patients with no residual blood (clean, 32.4%) presented a higher UFH dose (66.32 IU/kg) compared to overall average dose. UFH dose had a significant effect on dialyzer status. There were significant differences in average of spKt/V and SubsVol between the category clean and the other categories of dialyzer's status.Evaluating the dialyzer status represents an excellent opportunity to help the physicians to establish an ideal heparin dose. Only the category clean is significant to achieve the target. The nursing staff, by classifying the ECC appearance at patient's bedside and recording it in a centralized

Efficacy and Safety of Modified Polyethersulfone Hemodialysis Filters in Comparison to Conventional Filters: A Non-inferiority Clinical Trial

“…Fazendeiro Matos et al showed that the cleaner the filters were at the end of dialysis, the greater the dialysis adequacy with that type of filter. The aforementioned study also concluded that the more unfractionated heparin (UFH) was used, the less likely it was to form clots (18). According to this relationship, it might be concluded that a higher amount of UFH is required to reduce the possibility of blood clotting in new filters.…”

Effect of dialyzer geometry on coagulation activation in the extracorporeal circuit in maintenance hemodialysis patients: Prospective randomized trial

“…During the dialysis sessions, no infusions were given through the ECC. The dialyzer effect on coagulation activation was evaluated by calculating the absolute and percentage change of serum TAT levels and by visual inspection of the dialyzer status after the end of the session (Table 2), as described by Fazendeiro et al [14]. The grades of dialyzer status were assigned after consensus by two nephrologists.…”

Safety and performance of the Clearum™ high flux hemodialyzer

“…"Blood rest" is defined as a visual aspect of clotted or bloodstreaked fibers at the end of dialysis treatments after blood return. 11 To quantify the blood rest, the individual aspects of the dialyzers were compared to a set of 5 illustrations with an increasing amount of schematic blood rest, with 1 depicting the least and 5 depicting the highest amount of blood rest (Figure 2). Assessment was performed for FX-series at mid-week sessions during weeks 1 and 2, and Clearum filters at weeks 1, 3, and 6.…”