Vitamin E–Coated and Heparin-Coated Dialyzer Membranes for Heparin-Free Hemodialysis: A Multicenter, Randomized, Crossover Trial

Islam, Mohamed Shariful; Hassan, Zarih Alcheikh; Chalmin, Florence; Vido, Sandor; Berrada, M.; Verhelst, David; Donnadieu, Patrick; Moranne, Olivier; Esnault, Vincent

doi:10.1053/j.ajkd.2016.05.013

Cited by 32 publications

(34 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A possible alternative is represented by the use of heparin‐coated membrane, a material that has the ability to bind heparin in its surface providing predominantly a local anticoagulation effect . Results were, however, equivocal; circuit coagulation was reported with a frequency varying from 5 to 50% and early termination of dialysis session from 5% to 7% . We routinely used a modified polyacrylonitrile membrane (AN69ST) for HD sessions.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we did not experience an over‐clotting risk with predilutional HDF as compared to HD in our bleed risky patients unlike the Hepzero study . A blood flow rate maintained above 250 mL/min—a mean blood flow rate at 342 ± 63 mL/min in our study—may explain our results with both free‐heparin HD and HDF sessions . However, blood restitution quality was considered worse after HDF than after HD sessions.…”

Section: Discussionmentioning

confidence: 99%

“…Technical improvements including the use of citrate enriched dialysate have been developed or are in development but are not yet validated . A recent use of vitamin E‐coated dialyzer showed high failure of heparin‐free HD sessions and would not represent an alternative to heparin‐coated membrane for patients with heparin‐induced thrombocytopenia …”

Section: Discussionmentioning

confidence: 99%

“…Several dialysis procedures have been evaluated but they are non‐standardized and none of them have shown full efficacy in controlled studies . As a consequence, a coated‐heparin membrane has been developed but showed equivocal results . Hemodiafiltration (HDF) performed with a predilutional mode has also been proposed but again led to controversial results .…”

Section: Introductionmentioning

confidence: 99%

“…12,13 As a consequence, a coated-heparin membrane has been developed but showed equivocal results. 14,15 Hemodiafiltration (HDF) performed with a predilutional mode has also been proposed but again led to controversial results. 13,16 Yet, the best management of heparin-free RRT for chronic hemodialysis patients at risk of bleeding remains under scrutiny.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Heparin‐free renal replacement therapy for chronic hemodialyzed patients at high risk for bleeding: a comparison of on‐line predilution hemodiafiltration with conventional hemodialysis

Brunot

Serre

Mourad

et al. 2018

Hemodialysis International

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Heparin‐free renal replacement therapy for chronic hemodialyzed patients at high risk for bleeding: a comparison of on‐line predilution hemodiafiltration with conventional hemodialysis

Brunot

Serre

Mourad

et al. 2018

Hemodialysis International

View full text Add to dashboard Cite

show abstract

Improved hemocompatibility of polysulfone hemodialyzers with Endexo® surface modifying molecules

Fisher

Shao

2021

J Biomed Mater Res

View full text Add to dashboard Cite

Anticoagulation therapy is widely used to reduce clotting during hemodialysis (HD), but may cause adverse effects in end‐stage kidney disease patients. A new hemodialyzer with a membrane modified by surface modifying molecule was developed to improve hemocompatibility that aimed to reduce the need for anticoagulation during dialysis treatments. We compared membrane surface characteristics and in vitro hemocompatibility of the new hemodialyzer to the standard polysulfone (PSF) hemodialyzer membrane. Scanning electron microscopy, contact angle measurement (68° ± 3° test vs. 41.6° ± 6° control), and X‐ray photoelectron spectrometry measurement for fluorine atomic % (7.4% ± 0.4% test vs. not detectable control), showed that the membrane surface was modified with surface modifying macromolecule (SMM1) but maintained membrane structure and surface hydrophilicity. Zeta potential of the blood‐contacting surface showed that the absolute surface charge was reduced at neutral pH (−3.3 mV ± 1.1 mV test vs. −15.6 mV ± 1.0 mV control). Platelet count reduction was significantly less for the SMM1‐modified dialyzer (40.88% ± 21.89%) compared to the standard PSF dialyzer (62.62% ± 34.13%), along with Platelet Factor 4 (1824.10 ng/ml ± 436.26 ng/ml test vs. 2479.00 ng/ml ± 852.96 ng/ml control). These studies demonstrate the successful incorporation of SMM1 into the new hemodialyzer with the expected results. Our in vitro experiments indicate that the SMM1‐modified hemodialyzers could improve hemocompatibility compared to standard PSF hemodialyzers and have the potential to minimize the patient's anticoagulant requirements during HD. Additional research with SMM1 additives incorporated into the entire dialysis circuit and use in a clinical settings are required to confirm these promising findings.

show abstract

Enhancing dialyser clearance—from target to development

Tangvoraphonkchai

Davenport

2017

Pediatr Nephrol

View full text Add to dashboard Cite

Products of metabolism accumulate in kidney failure and potentially have toxic effects. Traditionally these uraemic toxins are classified as small, middle-sized and protein-bound toxins, and clearance during dialysis is affected by diffusion, convection and adsorption. As current dialysis practice effectively clears small solutes, increasing evidence supports a toxic effect for middle-sized and protein-bound toxins. Therefore, newer approaches to standard dialysis practice are required to look beyond urea clearance. Current dialysers have been developed to effectively clear small solutes and secondly to increase middle-sized toxin clearances. However, there is no ideal dialyser which can effectively clear all uraemic toxins. Advances in nanotechnology have led to improvements in manufacturing, with the production of smoother membrane surfaces and uniformity of pore size. The introduction of haemodiafiltration has led to changes in dialyser design to improve convective clearances. Both diffusional and convectional clearances can be increased by changing dialyser designs to alter blood and dialysate flows, and novel dialyser designs using microfluidics offer more efficient solute clearances. Adjusting surface hydrophilicity and charge alter adsorptive properties, and greater clearance of protein-bound toxins can be achieved by adding carbon or other absorptive monoliths into the circuit or by developing composite dialyser membranes. Other strategies to increase protein-bound toxins clearances have centred on disrupting binding and so displacing toxins from proteins. Just as the hollow fibre design replaced the flat plate dialyser, we are now entering a new era of dialyser designs aimed to increase the spectrum of uraemic toxins which can be cleared by dialysis.

show abstract

Vitamin E–Coated and Heparin-Coated Dialyzer Membranes for Heparin-Free Hemodialysis: A Multicenter, Randomized, Crossover Trial

Cited by 32 publications

References 56 publications

Heparin‐free renal replacement therapy for chronic hemodialyzed patients at high risk for bleeding: a comparison of on‐line predilution hemodiafiltration with conventional hemodialysis

Heparin‐free renal replacement therapy for chronic hemodialyzed patients at high risk for bleeding: a comparison of on‐line predilution hemodiafiltration with conventional hemodialysis

Improved hemocompatibility of polysulfone hemodialyzers with Endexo® surface modifying molecules

Enhancing dialyser clearance—from target to development

Contact Info

Product

Resources

About