Heparin-free hemodialysis with a polyacrylonitrile membrane.
The low in vitro thrombogenicity of polyacrylonitrile (AN-69) membrane may offer the possibility of performing hemodialysis (HD) with little or no heparin. The authors sought to reduce heparin dosage using AN-69 dialyzers at blood flows of 400 to 600 ml/min. Over a 90 day period, 2228 HDs were performed: 1531 (69%) with AN-69, 528 (24%) with regenerated cellulose (RC), and 169 (8%) with cellulose acetate (CA) dialyzers. Two hundred and eighty-three HDs were performed without systemic heparin; blood compartments were prerinsed with 2,000 U heparin in 1,000 ml of 0.9% saline. Saline flushes were used in cases of rising venous drip chamber pressures or visible clotting. Incidence of clotting overall in AN-69 HDs was 0.52% (8/1531), 2.8% (15/528) with RC, and 11.2% (19/169) with CA. In heparin-free HDs, incidence with AN-69 was 1.3% (3/230), 28.6% with RC (4/14), and 25.6% with CA (10/39). AN-69 remained less thrombogenic when HDs were stratified by blood flow rate and vascular access was used. Urea clearance was no different in conventional and heparin-free treatments. Blood flow rates of 400 ml/min or higher had an independent antithrombogenic effect. It was concluded that the combination of high blood flow with AN-69 membrane allows marked reduction of HD heparin dose and safe routine use of heparin-free HD.
Barth
R H
RH
Veterans Administration Medical Center, SUNY Health Science Center, Brooklyn 11209.
Sodden
S
S
Berlyne
G M
GM
D000180:Acrylic Resins; D001166:Arteriovenous Shunt, Surgical; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007688:Kidneys, Artificial; D008567:Membranes, Artificial; D010973:Platelet Adhesiveness / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects
D000180:Acrylic Resins; D008567:Membranes, Artificial; C010504:polyacrylonitrile; D006493:Heparin