title: Heparin-grafted dialysis membrane allows minimal systemic anticoagulation in regular hemodialysis patients: a prospective proof-of-concept study.
abstract: This prospective, multicenter, proof-of-concept study aimed to evaluate the possibility to reduce the ordinary heparin dose and the systemic anti-Xa activity during hemodialysis (HD) sessions using a new heparin-grafted HD membrane. In 45 stable HD patients, the use of a heparin-grafted membrane with the ordinary heparin dose was followed by a stepwise weekly reduction of dose. Reduction was stopped when early signs of clotting (venous pressure, quality of rinse-back) occurred during two out of three weekly HD sessions. Heparin dose was decreased for 67% of patients resulting in the lowering of these patients' anti-Xa activity by 50%. Dose reductions were achieved with both types of heparin (low-molecular-weight heparin: 64 ± 14 to 35 ± 12 IU/kg, P < 0.0001; unfractionated heparin: 82 ± 18 to 46 ± 13 IU/kg, P < 0.0001) resulting in a decrease of anti-Xa activity at dialysis session end (low-molecular-weight heparin: 0.51 ± 0.25 to 0.25 ± 0.11 IU/mL, P < 0.0001; unfractionated heparin: 0.28 ± 0.23 to 0.13 ± 0.07 IU/mL, P < 0.0001). Failure to further decrease heparin dose was related to signs of clotting in blood lines (57% of sessions), in dialyzer (9%), or both (34%). Significant reduction of heparin dose and anti-Xa activity at the end of HD sessions was possible in stable HD patients using heparin-grafted membrane. HD patients who require low anti-Xa activity at the end of HD sessions might benefit from a heparin-grafted membrane to reduce bleeding risk and other heparin adverse events.
authors.affiliation: Department of Nephrology, Hôpital Brabois, CHU, Vandoeuvre-lès-Nancy, France. m.kessler@chu-nancy.fr
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.forename: Concetta
authors.initials: C
authors.lastname: Gangemi
authors.forename: Alberto
authors.initials: A
authors.lastname: Gutierrez Martones
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Lacombe
authors.forename: Marie-Jeanne
authors.initials: MJ
authors.lastname: Krier-Coudert
authors.forename: Roula
authors.initials: R
authors.lastname: Galland
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Frédérique
authors.initials: F
authors.lastname: Moureau
authors.forename: Nathalie
authors.initials: N
authors.lastname: Loughraieb
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008567:Membranes, Artificial; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D008567:Membranes, Artificial