title: Post-dilution hemodiafiltration with a heparin-grafted polyacrylonitrile membrane.
abstract: The aim of this multicenter, prospective study was to explore the possibility of carrying out routine sessions of post-dilution hemodiafiltration with a polyacrylonitrile membrane grafted with heparin (HeprAN) and reduced anticoagulation. Forty-four patients from eight centers were included in the study and treated by means of post-dilution on-line hemodiafiltration with automatic control of TMP, according to three different modalities tested consecutively: phase 1, polyethersulfone filter primed with heparinized saline and anticoagulated with continuous infusion of unfractionated heparin 1000/h; phase 2, HeprAN membrane filter primed with saline without heparin. Anticoagulation: a 1000-unit bolus of unfractionated heparin at the start of session followed by a second one at the end of the second dialysis hour; phase 3, same filter and priming procedure as in phase 2; anticoagulation with nadroparin calcium at the beginning of treatment. Partial or massive clotting of the dialyzer occurred in less than 1% of sessions in phase 1; 10% and 7% in phase 2; and 1% and 2% in phase 3. Clotting limited to the drip chambers was observed in 13%, 34% and 12%, respectively. The study of coagulation parameters showed a better profile when low-molecular weight heparin (LMWH) was used in association with HeprAN membrane, while the generation of TAT complexes did not differ from that observed with the standard anticoagulation modality used in phase 1. Our results suggest that the HeprAN membrane can be used safely in routine post-dilution hemodiafiltration with reduced doses of LMWH.
authors.affiliation: Nephrology Unit, Ospedali Riuniti, Ancona, Italy.
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Frascà
authors.forename: Sibilla
authors.initials: S
authors.lastname: Sagripanti
authors.forename: Mario
authors.initials: M
authors.lastname: D'Arezzo
authors.forename: Simonetta
authors.initials: S
authors.lastname: Oliva
authors.forename: Angelo
authors.initials: A
authors.lastname: Francioso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mosconi
authors.forename: Loretta
authors.initials: L
authors.lastname: Zambianchi
authors.forename: Franco
authors.initials: F
authors.lastname: Sopranzi
authors.forename: Rolando
authors.initials: R
authors.lastname: Boggi
authors.forename: Laura
authors.initials: L
authors.lastname: Fattori
authors.forename: Angelo
authors.initials: A
authors.lastname: Rigotti
authors.forename: Laura
authors.initials: L
authors.lastname: Maldini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gattiani
authors.forename: Goffredo
authors.initials: G
authors.lastname: Del Rosso
authors.forename: Antonio
authors.initials: A
authors.lastname: Federico
authors.forename: Lidia
authors.initials: L
authors.lastname: Da Lio
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrante
mesh_terms: D000180:Acrylic Resins / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017583:Hemodiafiltration / Q000295:instrumentation* / Q000379:methods; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000180:Acrylic Resins; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D008567:Membranes, Artificial; C010504:polyacrylonitrile
keywords: Anticoagulation; Hemodiafiltration; Heparin; HeprAN; Polyacrylonitrile membrane