Influence of Various Membranes on the Coagulation System during Dialysis

Hildebrand, U.; Quellhorst, E

doi:10.1159/000410771

Cited by 10 publications

(2 citation statements)

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“…These observations, moreover, exclude the possiblity that the observed increase of Ht in the present investigation may be attrib uted to less blood left in PAN than in Cupro phan dialyzers due to the hypothetically dif ferent biocompatibility of the two mem branes [9,10], Therefore, on the basis of our Findings, the improvement of anemia could be attrib uted to a better removal of small uremic toxincs; in fact, the reduced removal by dialysis diffusion resulting from a significant de crease of the dialysis session time is more than compensated for by higher clearances, obtained by combining simultaneous diffu sion and high convection (mean UF higher than 100 ml/min) [2][3][4][5]. According to the above considerations, a significantly higher removal of small uremic toxins can be ex pected to improve anemia independently from the dialytic procedure employed.…”

Section: Discussionsupporting

confidence: 43%

Improvement of Anemia in Patients on Chronic Dialysis Treated by Hemodiafiltration

Gonella¹,

Pratesi²,

Calabrese³

et al. 1989

Blood Purif

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A group of patients with severe anemia on standard hemodialysis were transferred to polyacrylnitrile hemodiafiltration (HDF), which was arranged in order to obtain an ultrafiltration rate (UF) higher than 100 ml/min. During HDF, despite a significant reduction of the dialysis time, all patients had a significant decrease of predialytic BUN and serum creatinine, and a significant improvement of anemia. Furthermore, a close direct correlation was detected between the percent increase of hemoglobin and the length of time on HDF. Therefore, high-UF HDF represents a valid dialytic strategy to improve anemic states, permitting a significant reduction of the dialysis time and, thus, offering a better life quality for the patients.

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Section: Discussionsupporting

confidence: 43%

Improvement of Anemia in Patients on Chronic Dialysis Treated by Hemodiafiltration

Gonella¹,

Pratesi²,

Calabrese³

et al. 1989

Blood Purif

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“…However, no studies are available so far that compare the effects of different synthetic membranes on clinical outcome [ 1 ], although there are a lot of variances in thickness, pore size, pore number, and structure or symmetry between dialyser types. Furthermore, the biological profile of the group of synthetic membranes also differs: whereas coagulation profile [ 20 ] and leucopenia [ 21–24 ] are similar between PS and PMMA, the activation of granulocyte elastase is higher with PMMA membranes than with PS [ 23,25 ]. The most striking difference is the absorption: PMMA has a much higher protein absorption capacity than PS [ 27–29 ] and removes more middle-molecular-weight proteins [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of different synthetic membranes on laboratory parameters and survival in chronic haemodialysis patients

Kreußer¹,

Reiermann

Vogelbusch³

et al. 2010

Clinical Kidney Journal

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Background. A number of studies suggested that the type of dialysis membrane is associated with differences in long-term outcome of patients undergoing haemodialysis, both in terms of morbidity and mortality. In the majority of dialysis units, synthetic membranes are being used. However, no studies are available so far for comparison between different biocompatible membranes. Therefore, we studied the influence of high- and low-flux polysulphone membranes (PS) in comparison with polymethylmethacrylate (PMMA) membranes on mortality and morbidity on the basis of various laboratory parameters.Methods. In a cohort study, data of 260 consecutive haemodialysis patients entering our dialysis unit in the years 2003–07 were collected, comparing 435 PS patient-years and 85 PMMA patient-years. PMMA membranes (n = 33) were used for those patients who did not tolerate (e.g. for pruritus) PS membranes (n = 227). Low-flux dialysers (n = 233) were compared with high-flux (n = 37). Laboratory values were evaluated by unpaired t-test, and mortality was evaluated by log-rank test and Cox regression analysis adjusted for age, diabetes and laboratory parameters.Results. Patients in our dialysis unit had a high cardiovascular risk as demonstrated by a proportion of 63% of peripheral arterial disease. Despite this, cumulative survival was almost 60% after 5 years on dialysis. It was slightly but not significantly higher in patients on PMMA (68%) compared with PS dialysers (54%) and on high-flux (61%) versus low-flux membranes (54%). After accounting for the confounding effect of age and diabetes in the multivariate Cox regression analysis, there was no impact of the membranes used (high- or low-flux, PMMA or PS) on survival. Only age at the onset of dialysis showed a significant influence on survival (P ≤ 0.001). Independent predictors of mortality in all patients in the multivariate Cox regression analysis were age, haemoglobin, leucocytes, C-reactive protein (CRP) and creatinine. Laboratory parameters between the high- and low- flux groups were not different. PS-treated patients showed significantly (P ≤ 0.05) higher values for leucocytes, thrombocytes, ferritin, and CRP and lower values for haemoglobin, transferrin, creatinine, uric acid, creatine kinase (CK), and sodium than PMMA-treated patients. Irrespective of the membrane used, in deceased patients, the following laboratory values were higher than for patients alive: leucocytes, thrombocytes, ferritin and CRP; the following were lower: haemoglobin, iron, total protein, urea, creatinine, uric acid and CK.Conclusions. The data of 260 severely ill haemodialysis patients showed a slightly, but not significantly, reduced mortality in patients treated with PMMA membranes in comparison with PS and with high-flux membranes compared with low-flux. High- or low-flux membranes exhibited no difference in laboratory values. However, in PMMA patients, laboratory data with respect to inflammation, anaemia and nutrition were significantly improved compared with the PS group. A similarly positi...

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