SP472EFFICACY AND SAFETY OF VITAMIN E-BONDED POLYSULFONE DIALYZER ON NON-ANTICOAGULANT HEMODIALYSIS

Abstract

INTRODUCTION AND AIMS: Hemodialysis requires effective anticoagulation to prevent clotting. Systemic anticoagulation reduces clotting risk but also increases bleeding risk. Heparin is used to prevent clotting during hemodialysis, but anticoagulant-free hemodialysis is sometimes needed to decrease the risk of bleeding. Purpose of this study was to compare vitamin E-bonded polysulfone dialyzer (VPS) with polysulfone dialyzer (PS) during hemodialysis sessions without anticoagulant. METHODS: This open-label monocentric randomized study recruited chronic hemodialysis patients with a contra-indication to systemic heparinization. Thirty patients undergoing stable hemodialysis were randomly divided into VPS group (n=15) and PS group (n=15) after obtaining written informed consents. Exclusion criteria were as follows: inflammatory disorder with C-reactive protein level > 50 mg/L, anemia with blood transfusion requirement, and AV fistula dysfunction. To avoid total circuit clotting, 100-mL saline flushed every hour and visual inspections of dialysis circuit and dialyzer membrane was done. In cases of non-obstructive circuit clotting, membrane fiber clotting, or elevated arterial and/or venous pressure, continuous infusion of nafamostat mesilate was added to the hemodialysis circuit. At the end of the session, clotting status of dialysis circuit and dialyzer membrane was graded from 0 to 3 by visual inspection. As markers of coagulation status, fibrinogen, thrombin-antithrombin complex and Ddimers were measured at pre- and post- dialysis session. RESULTS: There was no significant difference between both groups in patients' profiles at baseline. Every hemodialysis session was not interrupted by major circuit clotting. PS membrane dialysis session was needed much more nafamostat mesilate addition compared with VPS. Partial circuit clotting evaluated by clotting grade was higher in PS than in VPS. Percent change of venous pressure after hemodialysis session increased in PS (+15.0%), but decreased in VPS (-2.5%, p<0.05). In coagulation status, percent change of D-dimers significantly increased in PS (+74.5%), compared with in VPS (+35.0%, p<0.05). CONCLUSIONS: These data suggest that VPS is safe and useful for non-anticoagulant hemodialysis in patients with contra-indication to systemic anticoagulation. However, results are not generalizable safely to patients with active infection, not assessed in the present study.