Hemodialysis using heparin-bound Hemophan in patients at risk of bleeding.
OBJECTIVE
Since heparin can bind to Hemophan, hemodialysis using heparin-bound Hemophan (HBH-HD) could be a useful modality in patients at risk of bleeding. We designed a simplified heparin binding technique and assessed the safety and efficiency of HBH-HD.


METHODS
To bind heparin to Hemophan, heparin solution (1 liter, 20 IU/ml saline) was recirculated through Hemophan (GFS plus 11, Gambro) for 1 h while the saline solution (700 ml/h) was removed. In 28 maintenance dialysis patients at risk of bleeding, we evaluated the heparin concentration (HC) and activated partial thromboplastin time (aPTT) during HBH-HD to assess the increased risk of bleeding. We compared the safety and efficiency of HBH-HD with that of routine hemodialysis with low-dose heparinization (R-HD) in a prospective cross-over study, and then analyzed the outcomes of 1,057 HBH-HD in 159 patients.


RESULTS
During HBH-HD, there was a slight increase in both HC (0.15 +/- 0.03 IU/ml, p < 0.01) and aPTT (43.7 +/- 5.7 s, p < 0.01) at 15 min after the initiation of dialysis compared to predialysis levels (0.11 +/- 0.03 IU/ml and 37.5 +/- 6.3 s). However, there was no increase in HC and aPTT at 60 min, 120 min and at the end of dialysis. In a cross-over study, aPTT during dialysis was markedly lower in HBH-HD than in R-HD (p < 0.01). The Kt/V (1.22 +/- 0.31, p > 0.05) and urea clearance (136 +/- 17 ml/min, p > 0.05) of HBH-HD did not significantly differ from those of R-HD (1.29 +/- 0.57 and 136 +/- 13 ml/min). However, the loss of total blood compartment volume of the dialyzer was greater in HBH-HD (17.5 +/- 9.2%, p < 0.01) than in R-HD (2.9 +/- 1.2%). Out of 1,057 HBH-HD, 982 HBH-HD (93%) were successfully completed while 75 HBH-HD (7%) resulted in severe clotting.


CONCLUSIONS
We conclude that the HBH-HD could minimize the bleeding risk and be an efficient HD technique in patients at high risk of bleeding. Careful observation for extracorporeal clotting is, however, required during HBH-HD.
Lee
Kyu-Beck
KB
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
Beom
B
Lee
Yoon-Ha
YH
Yoon
Soo-Jin
SJ
Kang
Woo-Hun
WH
Huh
Wooseong
W
Kim
Dae-Joong
DJ
Oh
Ha-Young
HY
Kim
Yoon-Goo
YG
D000327:Adsorption; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001672:Biocompatible Materials; D002482:Cellulose / Q000031:analogs & derivatives*; D018592:Cross-Over Studies; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006493:Heparin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*
D000925:Anticoagulants; D001672:Biocompatible Materials; C054645:Hemophan; D002482:Cellulose; D006493:Heparin