Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Tangvoraphonkchai, Kamonwan; Riddell, Anne; Davenport, Andrew

doi:10.1111/hdi.12586

Cited by 27 publications

(25 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study of Tangvoraphonkchai et al showed that dialyzer membranes, designed for high volume on‐line HDF, allow the achievement of high‐volume exchanges without an increased risk of ECC clotting and, no major differences between cellulosic and polysulfone dialyzers were found. There was no increase in microparticles, PF4, or thrombin antithrombin complexes (TATs) . In recent reports, the biocompatibility of the dialyzer membranes was monitored by the platelet count and it was concluded that the more biocompatible newer membranes, like the polysulfones, do not result in marked thrombocytopenia .…”

Section: Discussionmentioning

confidence: 60%

“…However, this potentially allows a greater change in hydrostatic pressure to occur as blood passes through the dialyzer and changes in pressure, and flow patterns may potentially lead to increased platelet and leukocyte activation and increase the risk of clotting in the extracorporeal circuit (ECC). 19 The study of Tangvoraphonkchai et al showed that dialyzer membranes, designed for high volume on-line HDF, allow the achievement of high-volume exchanges without an increased risk of ECC clotting and, no major differences between cellulosic and polysulfone dialyzers were found. There was no increase in microparticles, PF4, or thrombin antithrombin complexes (TATs).…”

Section: Discussionmentioning

confidence: 99%

“…There was no increase in microparticles, PF4, or thrombin antithrombin complexes (TATs). 19 In recent reports, the biocompatibility of the dialyzer membranes was monitored by the platelet count and it was concluded that the more biocompatible newer membranes, like the polysulfones, do not result in marked thrombocytopenia. 2,20 In our study, platelet count after the procedure was lower in the case of HD, as well as in the case of HDF, but the difference was statistically significant only in the case of HDF, although in both cases high-flux dialyzers were used.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelet closure time in patients with end stage renal disease

Knehtl

Jakopin

Dvoršak

et al. 2019

Hemodialysis International

View full text Add to dashboard Cite

Introduction: We aimed to compare prospectively the effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelets. Methods: Twenty‐two hemodialysis patients were treated with one high‐flux hemodialysis and one post‐dilution hemodiafiltration procedure. PFA‐100 closure times (collagen/epinephrine—CEPI and collagen/adenosine diphosphate—CADP) were measured before and after the procedure, as well as platelet count, hemoglobin, hematocrit, and red blood cell count. All pre‐dialysis and post‐dialysis samples were taken from the afferent line. Findings: The platelet count after vs. before hemodialysis did not change significantly (229.3 ± 55.0 x109/L vs. 233.6 ± 55.8 × 109/L; P = 0.269), but was significantly lower after post‐dilution hemodiafiltration (215.5 ± 51.7 × 109/L vs. 245.3 ± 59.9 × 109/L; P < 0.0001). CEPI after vs. before hemodialysis was not significantly prolonged (192.9 ± 60.8 s vs. 173.4 ± 52.5 s; P = 0.147), and the same applied to CADP (143.6 ± 40.3 s vs. 142.6 ± 38.4 s; P = 0.897). CEPI after vs. before post‐dilution hemodiafiltration was significantly prolonged (268.3 ± 41.3 s vs. 176.4 ± 54.0 s; P < 0.0001) as was CADP (221.0 ± 53.9 s vs.133.9 ± 31.1 s; P < 0.0001). Discussion: Only after post‐dilution hemodiafiltration, we found a lower platelet count and prolonged platelet closure times.

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelet closure time in patients with end stage renal disease

Knehtl

Jakopin

Dvoršak

et al. 2019

Hemodialysis International

View full text Add to dashboard Cite

show abstract

“…Similarly, although dialyzers designed for diffusion traditionally have very narrow internal fiber diameters to minimize the distance for diffusion, designed to increase diffusive clearance, narrow diameter fibers potentially increase the risk of haemoconcentration and clotting when used for haemodiafiltration. So, high‐flux dialyzers designed for haemodiafiltration have wider internal diameter fibers …”

Section: Haemodiafiltrationmentioning

confidence: 99%

“…So, high-flux dialyzers designed for haemodiafiltration have wider internal diameter fibers. 20 In pediatric practice, blood flows are generally much slower than in adult practice, and as such pre-dilutional haemodiafiltration is the more commonly performed. Pre-dilution reduces haemoconcentration, and although in theory would allow greater convective clearances, in clinical practice the removal of larger solutes such as alpha-1 macroglobulin do not differ between pre-and post-dilution modes, due to increased membrane adsorption with the post-dilution mode.…”

Section: Haemodiafiltrationmentioning

confidence: 99%

Moving beyond small solute clearance: What evidence is there for more permeable dialyzers and haemodiafiltration?

Davenport

2018

Hemodialysis International

Self Cite

View full text Add to dashboard Cite

Dialyzers were initially developed for diffusive clearance of uraemic toxins. Diffusion most effectively clears small uncharged solutes from plasma water, such as urea. Sessional urea clearance targets have been shown to be important for short‐term patient survival, but over the longer term, although low‐flux dialysis can prolong patient survival, accumulation of middle‐sized uraemic toxins, such as β2 microglobulin can lead to disabling arthropathy. Although the introduction of high‐flux dialyzers, designed to increase β2 microglobulin clearance, has reduced the prevalence of arthropathy; this has not been translated into a demonstrable significant improvement in patient survival. However, analysis of individual patients recruited into trials of haemo‐diafiltration reported that greater convective clearance was associated with better survival, although the individual trials reported mixed outcomes. Most haemodiafiltration trials were not designed to study the effect of convective dose, so although reported patient survival was greater for those receiving greater convective volume exchange, these results could potentially be confounded by patient or center effects. An alternative approach to increasing middle‐sized solute clearances would be to use more permeable dialyzers, but as yet there are no trials reporting survival with larger cutoff dialyzers. As such, although there is increasing evidence that increasing middle‐sized molecular uraemic solute clearance is associated with improved patient survival, further prospective trials are required to determine whether as with Kt/Vurea there is a threshold effect of how much convective or middle‐sized solute clearance is required to improve patient survival.

show abstract

Hemodialysis Does Not Induce Detectable Activation of the Contact System of Coagulation

François

Orlando

Jochmans

et al. 2020

Kidney International Reports

View full text Add to dashboard Cite

Introduction: Systemic anticoagulation is administered during hemodialysis to prevent clotting of the extracorporeal circuit. The role of contact system activation in thrombin generation during hemodialysis using current era dialyzer membranes is unknown. Methods:We performed a single-center randomized crossover study. Ten patients treated with hemodialysis underwent 3 standardized hemodialysis sessions. For every patient, each session was performed with a different type of dialyzer membrane (polyphenylene [PP], polymethylmetacrylate [PMMA], polyethylenimine-coated polyacrylonitrile [AN69ST]). Blood samples were collected before and 5, 15, 30, 90, and 240 minutes after blood pump start to evaluate coagulation activation (thrombin-antithrombin complex [TAT], prothrombin fragment 1þ2 [PF1þ2], activated factor XII [FXIIa], kallikrein, activated factor XI [FXIa]). Plasma of healthy volunteers (n ¼ 20) was used as a reference.Results: Baseline TAT and PF1þ2 levels were higher in hemodialysis patients compared to healthy controls (median [interquartile range] for TAT: 3.3 [2.9-4.2] vs. 2.4 [2.3-2.5] mg/l [P ¼ 0.0002] and for PF1þ2: 647 [478-737] vs. 138 [125-254] pmol/l [P < 0.0002]). Despite the use of systemic anticoagulation, TAT further increased during treatment, with the increase starting after 30 minutes (median TAT at t240: 9.0 mg/l (PP), 5.5 mg/l (PMMA), and 7.2 mg/l (AN69ST), all P < 0.05 vs. baseline). Contact system markers FXIIa and kallikrein did not differ significantly between dialysis patients and healthy controls, whereas baseline FXIa levels were significantly lower in dialysis patients compared to healthy controls (P ¼ 0.001). Levels of all contact system markers remained unchanged during hemodialysis with all types of dialyzer membranes. Conclusion:Routine hemodialysis using systemic heparin anticoagulation induces coagulation activation without measurable contact system activation.

show abstract

Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Abstract: Despite being pro-thrombotic, with activation of platelets, and lymphocytes during passage through ECC, no macroscopic clotting, or increased TATs were noted during OL-HDF, and no major differences between cellulosic and polysulphone dialyzers.

Cited by 27 publications

References 33 publications

The effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelet closure time in patients with end stage renal disease

The effect of high‐flux hemodialysis and post‐dilution hemodiafiltration on platelet closure time in patients with end stage renal disease

Moving beyond small solute clearance: What evidence is there for more permeable dialyzers and haemodiafiltration?

Hemodialysis Does Not Induce Detectable Activation of the Contact System of Coagulation

Contact Info

Product

Resources

About