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Monardo P, Lacquaniti A, Campo S, Bucca M, Casuscelli di Tocco T, Rovito S, Ragusa A, Santoro A. Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy. Semin Dial 2021; 34:183-195. [PMID: 33592133 DOI: 10.1111/sdi.12956] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/02/2020] [Indexed: 12/14/2022]
Abstract
Hemodialysis (HD) is a life-saving therapy for patients with end-stage renal disease. In dialyzed patients, the prevalence of multi-morbidity is rising driven by various factors, such as the population aging, the incomplete correction of uremia, and the side effects of the dialysis therapy itself. Each dialyzed patient has their own specific clinical and biochemical problems. It is therefore unthinkable that the same dialysis procedure can be able to meet the needs of every patient on chronic dialysis. We have very sophisticated dialysis machines and different dialysis techniques and procedures beyond conventional HD, such as hemodiafiltration (HDF) with pre- and post-dilution, acetate-free biofiltration (AFB), hemofiltration (HF), and expanded HD. Each of these techniques has its own specific characteristics. To solve some intradialytic clinical issues, such as arterial hypotension and arrhythmias, we have biofeedback systems with automatic regulation of the blood volume, body temperature, arterial pressure, as well as potassium profiling techniques in the dialysis bath. New technical innovations, such as citrate-containing dialysate or heparin-coated membranes, could reduce the risk of bleeding. To better address to patient needs, the strengths and weaknesses of each of these systems must be well-known, in order to have a personalized dialysis prescription for each patient.
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Affiliation(s)
- Paolo Monardo
- Nephrology and Dialysis Unit, Papardo Hospital, Messina, Italy
| | | | - Susanna Campo
- Nephrology and Dialysis Unit, Papardo Hospital, Messina, Italy
| | - Maurizio Bucca
- Nephrology and Dialysis Unit, Papardo Hospital, Messina, Italy
| | | | - Stefania Rovito
- Nephrology and Dialysis Unit, Papardo Hospital, Messina, Italy
| | - Antonino Ragusa
- Nephrology and Dialysis Unit, Papardo Hospital, Messina, Italy
| | - Antonio Santoro
- Department of Organ Failures and Transplantations, Policlinico S.Orsola-Malpighi- Bologna, Italy
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Krummel T, Cellot E, Thiery A, De Geyer G, Keller N, Hannedouche T. Hemodialysis without anticoagulation: Less clotting in conventional hemodialysis than in predilution hemodiafiltration. Hemodial Int 2019; 23:426-432. [PMID: 31380605 DOI: 10.1111/hdi.12774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/22/2019] [Accepted: 06/23/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Hemodialysis patients with contraindication to systemic anticoagulation require a heparin-free hemodialysis technique. Among several alternatives to heparin, predilution hemodiafiltration (HDF) is often used, albeit without any confirmation of its effectiveness. METHODS Patients hospitalized in a nephrology ICU and hemodialysed for stage 5 CKD or AKI and with contraindication to systemic anticoagulation were randomized to either standard HD with a polysulfone membrane, or to predilution HDF with the same membrane. Coagulation activation was evaluated clinically by the need for premature termination and by the measurement of D-dimers. FINDINGS Two hundred dialysis sessions were performed in 155 patients. Survival curves showed better circuit survival in HD (P = 0.046). In HD, 12% of sessions were interrupted for coagulation versus 23% in predilution HDF (P = 0.04). DISCUSSION Predilution HDF was associated with more premature clotting than conventional HD without improvement in dialysis duration or performance epuration indices. When aiming for a 4-hour duration session, conventional heparin-free hemodialysis can be safely proposed in most patients with high bleeding risk.
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Affiliation(s)
- Thierry Krummel
- Department of Nephrology and Dialysis, University Hospital of Strasbourg, Strasbourg, France
| | - Etienne Cellot
- Department of Nephrology, General Hospital of Annecy, Annecy, France
| | - Alicia Thiery
- Department of Public Health, Centre Paul Strauss, Strasbourg, France
| | - Géraldine De Geyer
- Department of Nephrology and Dialysis, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Keller
- Department of Nephrology and Dialysis, University Hospital of Strasbourg, Strasbourg, France
| | - Thierry Hannedouche
- Department of Nephrology and Dialysis, University Hospital of Strasbourg, Strasbourg, France
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Li J, Sun S, Han M, Wang L, Liao R, Xiong Y, Li Y, Jiang H, Qin Z, Maharjan A, Cozzolino M, Zarbock A, Su B. The effects of citrate dialysate in hemodialysis on polymorphonuclear elastase interaction with tissue factor and its inhibitor. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:391. [PMID: 31555705 PMCID: PMC6736810 DOI: 10.21037/atm.2019.07.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 12/02/2023]
Abstract
BACKGROUND This study aimed to investigate whether hemodialysis (HD) affects tissue factor (TF), tissue factor pathway inhibitor (TFPI), and polymorphonuclear elastase (PMNE) in endstage renal disease (ESRD) patients when eliminating the effects of heparin. Also, to explore the interaction of TF, TFPI, and PMNE throughout a single HD session. METHODS We enrolled 57 ESRD patients who had undergone hemodialysis for >3 months as an experimental group. Plasma levels of TF, TFPI and PMNE were measured by ELISA in 24 ERSD patients on intermittent HD using low-molecular-weight heparin (LMWH) as anticoagulation (LMWH group) and 33 ESRD patients using citrate as anticoagulation (citrate group) at the start and at 1, 2 and 5 h of the HD session. Meanwhile,28 ESRD patients not on dialysis were enrolled as a control group and fasting venous blood samples were taken in the morning. RESULTS Compared with the control group, the plasma TFPI levels of the LMWH group and the citrate group were significantly higher (P=0.000, P=0.002, respectively) under baseline conditions as well as the plasma PMNE levels (P=0.001, P=0.02, respectively), whereas TF showed no difference (P=0.186). During HD with citrate, plasma TFPI decreased slightly (P=0.012) and PMNE increased significantly (P=0.008) at 1 h. The plasma TFPI levels of the citrate group correlate with PMNE at 2 and 5 h (P=0.001, P=0.008, respectively). CONCLUSIONS ESRD patients on HD have significantly higher TFPI and PMNE levels compared to patients not on HD under baseline conditions, while TF levels were similar between the three groups. TFPI and PMNE are differently regulated, but the plasma levels correlated during HD in the citrate group. It might be possible that PMNE plays a role in anticoagulative activity through TFPI.
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Affiliation(s)
- Jiameng Li
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Si Sun
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Mei Han
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liya Wang
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ruoxi Liao
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yuqin Xiong
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yupei Li
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Heng Jiang
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zheng Qin
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Anil Maharjan
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Mario Cozzolino
- Renal Division and Laboratory of Experimental Nephrology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, Germany
| | - Baihai Su
- Department of Nephrology, Faculty of Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
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