Expanded hemodialysis: Is anticoagulation of the dialysis circuit different from online hemodiafiltration and high-flux hemodialysis?
Por:
Santos, A, Macias, N, Vega, A, Abad, S, Linares, T, Aragoncillo, I, Cruzado, L, Pascual, C, Goicoechea, M and Lopez-Gomez, J
Publicada:
1 feb 2022
Ahead of Print:
1 abr 2021
Resumen:
Expanded hemodialysis (HDx) has a high capacity for removing medium and medium-large molecules; however, there are no specific recommendations during HDx for anticoagulation of the dialysis circuit. We aimed to evaluate the differences in the efficacy of anticoagulation procedures using the venous port and 40 mg enoxaparin in HDx compared to high-flux hemodialysis (HF-HD) and postdilution online hemodiafiltration (HDF). We compared anticoagulant activity in 11 patients in HDx, HF-HD, and HDF under similar dialysis conditions. In the 33 dialysis sessions, 40 mg enoxaparin was administered through the venous port, and pre- and postdialysis antifactor Xa activity (aXa) and activated partial thromboplastin time (APTT), postdialysis clotting time of the vascular access, visual clotting score of the dialyzer, and any complications with the extracorporeal circuit or bleeding were registered. APTT postdialysis in HDx was not significantly different from that in HF-HD and HDF. Postdialysis aXa in HDx was not significantly different from that in HF-HD and HDF. We found no significant differences in visual clotting score of the dialyzer. Enoxaparin administered through the venous port was sufficient for anticoagulation within the extracorporeal circuit in HDx, HF-HD, and HDF. There were no differences in postdialysis aXa or APTT, most likely because when low molecular-weight heparin is applied through venous port, lesser enoxaparin concentration reaches the dialyzer. Thus, we conclude that the dose of enoxaparin administered through the venous port should not be adjusted according to dialysis technique.
Filiaciones:
Santos, A:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
Macias, N:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
Vega, A:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
Abad, S:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
Linares, T:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
Aragoncillo, I:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
:
Hosp Univ Elche, Dept Nephrol, Elche, Spain
Pascual, C:
Hosp Gen Univ Gregorio Maranon, Dept Hematol, Madrid, Spain
Goicoechea, M:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
Lopez-Gomez, J:
Hosp Gen Univ Gregorio Maranon, Dept Nephrol, C Dr Esquerdo 46, Madrid 28007, Spain
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