A randomized cross-over study with objective quantification of the performance of an asymmetric triacetate and a polysulfone dialysis membrane using different anticoagulation strategies
Autor: | Iván Josipovic, Sunny Eloot, Wim Van Biesen, Annemieke Dhondt, Matthieu Boone, Floris Vanommeslaeghe |
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Rok vydání: | 2019 |
Předmět: |
EXPRESSION
Nephrology HEMODIALYSIS medicine.medical_specialty HIGH-FLUX DIALYZERS medicine.medical_treatment micro-CT scan 030232 urology & nephrology Urology 030204 cardiovascular system & hematology Extracorporeal Dialysis tubing 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine REGIONAL CITRATE ANTICOAGULATION Internal medicine Medicine and Health Sciences BIOINCOMPATIBILITY medicine Polysulfone AcademicSubjects/MED00340 anticoagulation polymers RISK Transplantation Errata business.industry Original Articles clotting EFFICACY Crossover study SAFE haemodialysis chemistry Systemic anticoagulation Hemodialysis business |
Zdroj: | CLINICAL KIDNEY JOURNAL Clinical Kidney Journal |
ISSN: | 2048-8513 2048-8505 |
Popis: | Background Different strategies can be used to counteract coagulation of extracorporeal systems. Systemic anticoagulation is most widely used in routine clinical practice, but can be contraindicated in specific settings. The Solacea™ dialyser, containing the asymmetric triacetate membrane, claims improved biocompatibility, which should result in decreased tendency for coagulation. We quantified the performance of the Solacea™ versus the FX800CORDIAX dialyser regarding resistance to fibre blocking as assessed by micro-computed tomography (CT). Methods This cross-over study with four arms randomized consecutively 10 maintenance haemodialysis patients to a 4-h post-dilution haemodiafiltration session at midweek, using either Solacea™ 19 H or FX800CORDIAX, with either regular or half dose of anticoagulation (EC2017/1459-NCT03820401). Dialyser fibre blocking was visualized in the dialyser outlet potting using a 3D CT scanning technique on micrometre resolution. Extraction ratios of middle molecules [myoglobin, lambda and kappa free light chains (FLCs)] were determined. Results The relative number of open fibres post-dialysis was lower in FX800CORDIAX versus Solacea™ dialyser, and this was irrespective of the anticoagulation dose used or the threshold for counting open fibres. Extraction ratios of FLCs were not different at regular anticoagulation between Solacea™ and FX800CORDIAX (21% ± 4% for kappa and 32% ± 8% for lambda with Solacea™ versus 23% ± 7% and 38% ± 6% for FX800CORDIAX), but were superior with the Solacea™ (34% ± 12% versus 22% ± 8% with FX800CORDIAX; P = 0.02) for myoglobin in case of halving anticoagulation dose. No clinically relevant albumin loss was detected. Conclusions The Solacea™ dialyser seems to be promising for use in conditions where systemic anticoagulation is contraindicated, as even under conditions of low systemic anticoagulation, virtually no signs of fibre blocking could be observed using the sensitive micro-CT scanning technique. This finding is in line with its presumed good performance in terms of biocompatibility. |
Databáze: | OpenAIRE |
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