| The clinical evaluation of low-dose heparin in haemodialysis: a prospective study using the heparin-coated AN69 ST membrane. | |
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MedLine Citation:
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PMID: 18156457 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The AN69 ST haemodialysis membrane, a new membrane resulting from coating polyethyleneimine upon the polyacrylonitrile surface, binds heparin. In patients at risk of bleeding, a pilot study has demonstrated the efficient anticoagulant effect of this heparin-coated membrane. Study design. In chronic haemodialyzed patients, we evaluated whether this anticoagulant effect can be validated in a controlled, prospective, open study. Pragmatically, we tested the hypothesis of no difference of the massive clotting rate in two groups of patients haemodialyzed either with 50% reduced standard doses of nonfractionated heparin using the heparin-coated AN69 ST or with a full dose of heparin (100%) using another type of dialysis membrane that does not bind heparin. Secondary objectives included evaluation of partial clotting, changes in haemoglobin levels, erythropoietin consumption and dialyzer performances. RESULTS: One hundred and eighty-four patients were elected and 170 finally included in an 18-month follow-up study. They were allocated to one of the two arms of the study. In the heparin-reduced group (n = 85, mean age: 73 +/- 11 years), 12 472 sessions were performed after priming the AN69 ST dialyzer with 2 L of heparinized saline (5000 IU/L heparin) and using 50% reduced doses of previously administered heparin. In the control group with standard heparin (n = 85, mean age: 74 +/- 13 years), 14 154 sessions were analysed (NS), and mean heparin doses were 2718 +/- 1388 and 4800 +/- 1564 IU per session, respectively (P < 0.001). In the heparin-reduced group, massive clotting occurred in 1.4 per 1000 sessions, whereas it occurred in 1.6 per 1000 sessions in the standard heparin group (P < 0.05). Mild to moderate partial clotting in the venous drip chamber and in the dialyzer was evaluated in a subset of patients, on a visual scale. It was more frequent in the experimental group than in the control group (P < 0.001). Platelets, haemoglobin levels, erythropoietin needs and dialyzer performances remained unchanged in both groups. The global mean death rate was 16.8% per year and did not differ significantly between groups. CONCLUSION: The use of the heparin-coated AN69 ST membrane allows a 50% reduction of standard doses of nonfractionated heparin administration for routine haemo- dialysis without increasing the risk of massive clotting of the extracorporeal circuit. This result needs confirmation since massive clotting questions clinical practice and is team dependent. |
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Authors:
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Jacques Chanard; Sylvie Lavaud; Hervé Maheut; Isabelle Kazes; Fabien Vitry; Philippe Rieu |
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Publication Detail:
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Type: Controlled Clinical Trial; Journal Article Date: 2007-12-21 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 23 ISSN: 1460-2385 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-05-21 Completed Date: 2008-07-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 2003-9 Citation Subset: IM |
Affiliation:
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Service de néphrologie, Centre Hospitalier et Universitaire, REIMS, France. jchanard@chu-reims.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acrylic Resins Age Distribution Aged Aged, 80 and over Coated Materials, Biocompatible Dose-Response Relationship, Drug Equipment Failure Equipment Safety Female Follow-Up Studies Heparin, Low-Molecular-Weight / administration & dosage* Humans Kaplan-Meiers Estimate Kidney Failure, Chronic / diagnosis, mortality, therapy* Male Membranes, Artificial* Middle Aged Probability Prospective Studies Renal Dialysis / instrumentation*, methods Risk Assessment Sex Distribution Statistics, Nonparametric Survival Analysis Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Acrylic Resins; 0/Coated Materials, Biocompatible; 0/Heparin, Low-Molecular-Weight; 0/Membranes, Artificial; 25014-41-9/polyacrylonitrile |
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