Evaluation of Platelets and Hemostasis during Hemodialysis with Six Different Membranes

Abstract

Hemodialysis induces thrombocytopenia and activation of coagulation. The severity of this reaction depends on the kind of membrane. In this study, we present the results of determination of platelet count, and of different factors of coagulation in 10 stable dialysis patients. Measurements were performed at the start and after 15 and 45 min of dialysis. Samples were taken before and after the dialyzer. All 10 patients were treated consecutively and in a random order during 14 days with the following membranes: polyacrylonitrile (Filtral 12, Hospal), hemophan (GFS 120 Plus, Gambro, and Bio-Nephros HF Andante, Organon), polysulfone (F6, Fresenius), cuprammonium (AM50-BIO, Asahi) and cellulose acetate (Duo-Flux, Cordis-Dow). The cellulose acetate membrane induced a small but significant drop of mean platelet count [results are mean (SEM)]: from 245,000 (17,000) to 224,000 (16,000)/μl after 15 min. With the same membrane a dramatic increase after 15 min was noted of 6-keto-PGF1α from 56.3 (9) to 146.7 (35.7) pg/ml. The other membranes did not influence significantly prostanoid levels and platelet count. During dialysis no significant changes of fibrinopeptide A (FPA) and von Willebrand factor (VWF) were observed. Nevertheless, predialysis FPA and β-thromboglobulin (βTG) concentrations were lowest after 14 days of treatment with cellulose acetate and polyacrylonitrile membranes. It is concluded that the activation of coagulation depends on the membrane used. The activation may be dominated by one single system (e.g. prostanoids). The different predialysis concentration of some of the factors suggests interference of the dialysis membrane with the activation of coagulation during the interdialytic period.

The clinical diagnosis of heparin-induced thrombocytopenia in patients receiving continuous renal replacement therapy

“…Still other dialyzers may predispose to the generation of PF4-H antibodies [20]. However, platelet loss, platelet consumption and PF4-H antibody production have not been associated with the polysulphone dialyzer used in our study [20,26,27].…”

“…In addition, ICU patients who are more critically ill and thus require CRRT likely have more medications, organ failure and additional etiologies that lead to thrombocytopenia. A small loss of platelets through the hemofilter used during CRRT [25] or platelet activation and consumption through the contact system may also occur through blood interaction with certain dialyzers [26,27]. Still other dialyzers may predispose to the generation of PF4-H antibodies [20].…”

Biocompatibility of Haemodialysis Membranes: Haemodialysis-Related Leukotriene B₄ and C₄ Generation

“…(b) Hypoxemia, related mostly to alveolar hypoventilation secondary to bicarbon ate loss in the dialysis fluid [3] and probably also to the secretion of vasoconstrictor humoral mediators such as thromboxane (Tx) A2 [4]. (c) Blood clotting produced by activation of the coagulation pathway and by platelet acti-vation [5,6]. (d) Activation of polymorphonuclear neu trophils (PMN) with a release of reactive oxygen radicals, intracellular enzymes, cytokines and eicosanoids [7], (e) Hypereosinophilia, especially with CUP membranes, complicated by 'asthmatic' dyspnoea or cutaneous mani festations [8].…”

“…In general, most side effects were observed with CUP membranes [ 1-4,6. 7] and to a lesser extent with polyacrylonitrile (PAN) membranes [5][6][7], Although several differences in bio compatibility between these membranes may be ex plained by the degree of human anaphylatoxin (C3a and C5a) generation and adsorption [9], not all side effects have been fully explained. Some of them depend on the release of cellular humoral mediators whose biological effects recall pathophysiological events of bioincompati bility.…”

Thrombocytopenia in the Setting of Hemodialysis Using Biocompatible Membranes

“…Complement activation occurred specifically in the setting of cuprophane membranes, and thrombocytopenia was only observed in the presence of complement activation [4]. Verbeelen et al showed that cellulose acetate dialyzer membranes can also cause transient thrombocytopenia and platelet activation [6]. In contrast, there were no changes in platelet levels and decreased complement activation when dialysis was undertaken using noncellulose polymethylmethacrylate membranes [5].…”