USE OF EVODIAL DIALIZERS FOR HEMODIALYSIS IN PATIENTS WITH HIGH RISK FOR BLEEDING - SINGLE CENTRE EXPERIENCE

  • Vladimir Pushevski University Clinic of Nephrology, Faculty of Medicine,"Ss. Cyril and Methodius" University in Skopje, North Macedonia
  • Aleksandra Canevska University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Zaklina Sterjova Markovska University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Ana Marija Shpishikj Pushevska Special Hospital, Mother Theresa, Faculty of Medicine, "Ss. Cyril and Methodius", University in Skopje, North Macedonia
  • Mimoza Milenkova University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
  • Irena Rambabova Busletik University Clinic for Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia

Abstract

During hemodialysis exposure of the blood to the dialysis membrane can promote clotting. So, usually anticoagulation is used. In patients with increased risk for bleeding heparin-free regime is mandatory. Evodial dialyzer contains a heparin-grafted membrane in order to reduce patients' bleeding risk. In this study we are showing our experience with the use of Evodial dialyzer.  We report 106 dialysis sessions in 59 patients were performed. Reasons for using Evodial: active bleeding, hematological conditions, complications of vascular access. Changes in the dialyzer or additional interventions were examined. Low-dose unfractionated heparin was used in 10 (9,4%) sessions, and was added in 6 (5.7%) more and in another 5 ( 4,7%) saline flushing. In 4 (3,8%) sessions due to coagulation we had to terminate dialysis. Heparin-grafted dialyzers can be safely used in patients with high-risk for bleeding as reasonable alternative when regional citrate anticoagulation is unavailable.


 Key words: Evodial, heparin-free dialysis, chronic kidney disease, high-risk for bleeding.


https://doi.org/10.55302/JMS2361098p


 

References

1. Craddock PR, Fehr J, Brigham KL, Kronenberg RS, Jacob HS. Complement and leukocyte-mediated pulmonary dysfunction in hemodialysis. N Engl J Med. 1977;297(14):769–774.
2. Hakim RM, Breillatt J, Lazarus J, Port FK. Complement activation and hypersensitivity reactions to dialysis membranes. N Engl J Med. 1984;311(14):878–882.
3. Boyer CJ, Swartz RD. Severe clotting during extracorporeal dialysis procedures. Semin Dial. 1991;4(2):69–71
4. Daugirdas JT, Blake PG, Ing TS. Chapter 14: anticoagulation. In: Handbook of Dialysis. 5th edn. Philadelphia, Penn: Wolters Kluwer 2014:254–255.
5. van Rein, N.; Biedermann, J.S.; van der Meer, F.J.M.; Cannegieter, S.C.; Wiersma, N.; Vermaas, H.W.; Reitsma, P.H.; Kruip, M.; Lijfering, W.M. Major bleeding risks of different low-molecular-weight heparin agents: A cohort study in 12 934 patients treated for acute venous thrombosis. J. Thromb Haemost. 2017, 15, 1386–1391. [CrossRef] [PubMed]
6. Nelson-Piercy, C. Hazards of heparin: Allergy, heparin-induced thrombocytopenia and osteoporosis. Baillikres Clin. Obstet. Gynaecol. 1997, 11, 489–509.
7. Murray PT, Reddy BV, Grossman EJ, et al. A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease. Kidney Int. 2004;66:2446–2453.
8. Reddy BV, Grossman EJ, Trevino SA, Hursting MJ, Murray PT. Argatroban anticoagulation in patients with heparin-induced thrombocytopenia requiring renal replacement therapy. Ann Pharmacother. 2005;39:1601–1605.
9. Pöschel KA, Bucha E, Esslinger H-U, et al. Anticoagulant efficacy of PEG-Hirudin in patients on maintenance hemodialysis. Kidney Int. 2004;65:666–674.
10. Van Wyk V, Badenhorst PN, Luus HG, Kotze HF. A comparison between the use of recombinant hirudin and heparin during hemodialysis. Kidney Int. 1995;48:1338–1343.
11. Wellborn-Kim JJ, Mitchell GA, Terneus WF, et al. Fondaparinux therapy in a hemodialysis patient with heparin-induced thrombocytopenia type II. Am J Heal Pharm. 2010;67:1075–1079.
12. Mahieu E, Claes K, Jacquemin M, et al. Anticoagulation with fondaparinux for hemodiafiltration in patients with heparin-induced thrombocytopenia: dose-finding study and safety evaluation. Artif Organs. 2013;37(5):482–494.
13. Magnani HN. A review of 122 published outcomes of danaparoid anticoagulation for intermittent haemodialysis. Thromb Res. 2010;125(4):e171–e176
14. Krummel T, Scheidt E, Borni-Duval C, et al. Haemodialysis in patients treated with oral anticoagulant: should we heparinize? Nephrol Dial Transplant. 2014;29(4):906–913.
15. Buturovic-Ponikvar J. Is regional citrate anticoagulation the future of hemodialysis? Ther Apher Dial. 2016;20(3):234–239.
16. Skagerlind MS, Stegmayr BG. An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis. Eur J Clin Pharmacol. 2018;74:267–274.
17. Vanommeslaeghe F, De Somer F, Josipovic I, Boone M, Van Biesen W, Eloot S. Evaluation of different dialyzers and the impact of predialysis albumin. Kidney Int Reports. 2019;4:1538–1545.
18. Skagerlind M, Stegmayr B. Heparin albumin priming in a clinical setting for hemodialysis patients at risk for bleeding. Hemodial Int. 2017;21:180–189.
19. Frank RD, Mu U, Lanzmich R, Groeger C, Floege J. Anticoagulant free Genius haemodialysis using low molecular weight heparin-coated circuits. Nephrol Dial Transplant. 2006;21:1013–1018.
20. Fransson F, Kyrk T, Skagerlind M, Stegmayr B. Rinsing the extra corporeal circuit with a heparin and albumin solution reduces the need for systemic anticoagulant in hemodialysis. Int J Artif Organs. 2013;36(10):725–729
21. Guery B, Alberti C, Servais A, et al. Hemodialysis without systemic anticoagulation: a prospective randomized trial to evaluate 3 strategies in patients at risk of bleeding. PLoS One. 2014;9(5):e97187
22. Laville M, Dorval M, Fort Ros J, et al. Results of the HepZero study comparing heparin-grafted membrane and standard care show that heparin-grafted dialyzer is safe and easy to use for heparin-free dialysis. Kidney Int. 2014;86:1260–1267.
23. Morena M, Jaussent I, Chalabi L, et al. Biocompatibility of heparin-grafted hemodialysis membranes: impact on monocyte chemoattractant protein-1 circulating level and oxidative status. Hemodial Int. 2010;14:403–410.
24. Chanard J, Lavaud S, Kazes I, Vitry F, Rieu P. The clinical evaluation of low-dose heparin in haemodialysis: a prospective study using the heparin-coated AN69 ST membrane. Nephrology. 2008;23:2003–2009
25. Wu X, Chen H. Clinical study of heparin-free hemodialysis with the inside of hollow fibers in dialyzer coated by human albumins. Nephron. 2002;92:925–928
26. Kiaii M, Aritomi M, Nagase M, Farah M, Jung B. Clinical evaluation of performance, biocompatibility, and safety of vitamin E-bonded polysulfone membrane hemodialyzer compared to non-vitamin E-bonded hemodialyzer. J Artif Organs. 2019;22(4):307–315.
27. Lines SW, Carter AM, Dunn EJ, Lindley EJ, Tattersall JE, Wright MJ. A randomized controlled trial evaluating the erythropoiesis stimulating agent sparing potential of a vitamin E-bonded polysulfone dialysis membrane. Nephrol Dial Transplant. 2014;29:649–656.
28. Kessler M, et al. Heparin-grafted dialysis membrane allows minimal systemic anticoagulation in regular hemodialysis patients: A prospective proof-of-concept study. Hemodial Int 2013; 17:282-293
Published
2023-05-10
How to Cite
PUSHEVSKI, Vladimir et al. USE OF EVODIAL DIALIZERS FOR HEMODIALYSIS IN PATIENTS WITH HIGH RISK FOR BLEEDING - SINGLE CENTRE EXPERIENCE. Journal of Morphological Sciences, [S.l.], v. 6, n. 1, p. 98-103, may 2023. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol6no1-13>. Date accessed: 27 feb. 2024.
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Articles