Hemodialysis Using Heparin Bound Hemophan in Chronic Dialysis Patients with High Risk of Bleeding

Kim, Yoon Goo; Lee, Kyu Beck; Kim, Beom; Lee, Yoon Ha; Kim, Dae Joong; Oh, Ha Young; Jang, Se Ho

Abstract

Systemic anticoagulation in routine hemodialysis is not desirable in patients with high risk of bleeding. Since heparin can bind to Hemophan, we evaluated the risk of bleeding and efficiency of hemodialysis using heparin bound Hemophan membranes in patients with high risk of bleeding. Heparin solution (1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1hour while removing saline solution(700ml/hr) by application of transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. As a pilot study, we performed 17 hemodialyses on 15 chronic dialysis patients with contraindication to systemic anticoagulation. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. Blood samples were obtained to measure activated partial thromboplastin time (aPTT), and heparin concentrations (HC) before dialysis, at 15min, 60min, 120min after initiation of dialysis and at the end (240min) of dialysis. Dialysis efficiency was assessed by measuring Kt/V and urea clearance of dialyzer (K) by the direct quantification of dialysate urea and then compared with the 25 control dialyses with systemic anticoagulation. We successfully completed all 17 hemodialyses without severe clotting defined as, requiring replacement of the dialyzer and/or the extracorporeal blood lines. There was a slight increase in the aPTT (mean+/-SD, 42.9+/-4.4sec) and HC (0.15+/-0.03IU/ml) taken at 15min from predialysis levels of 36.3+/-6.3sec and 0.11+/-0.03U/ml, respectively. But no increase in aPTT, HC was observed in measurements taken at 60min, 120min, and at the end of dialyses. The value (mean+/-SD) of Kt/V and K was 1.27+/-0.25 and 134+/-19ml/min respectively, which did not differ from those of the control dialyses which was 1.24+/-0.21 and 136+/-13ml/min respectively. We performed 82 hemodialyses using such treated Hemophan on 27 patients for 4 hours basing the result of the pilot study. Clotting of dialyzer necessitating termination of dialysis occurred in 1 dialysis(1.2%) at 150min and clotting in the venous blood lines requiring change of blood lines occurred in 6 dialyses(7.3%) on 4 patients from 180min to 230min after initiation of dialysis. We conclude that the use of heparin bound Hemophan can be a safe and effective technique of hemodialysis with careful monitoring of extracorporeal clotting in patients with high risk of bleeding.