The research on making use of hemophan dialyzer in the application of heparin-free hemodialysis / 中国实用护理杂志

0.05).Every one of the patients completed hemodialysis except one needing to rebuild blood circulation by changing another dialyzer, whose vein pressure became higher and the dislyzer was of cruor as it was difficult to build blood circulation. The rate of success has reached 99 percent. Conclusion There is no influence upon the general cruor mechanism when using hemophan dialyzers to heparin-free hemodialysis treat the acute or chronic renal failure. This simple method is not only effective but also safe, which can provide a reliable measure to rescue patients suffering from acute or chronic renal failure with serious tendency of hemorrhage.

Comparison of Safety and Efficiency of Hemodialysis Using Heparin-bound Hemophan with those of Saline Flushing Hemodialysis and Hemodialysis Using Low Dose Heparin in Patients at Risk of Bleeding / 대한신장학회잡지

OBJECTIVE: Although hemodialysis using heparin bound Hemophan (HBH-HD) has been reported to be a possible modality in patients at risk of bleeding, the efficiency and safety of HBH-HD is not certain. Therefore, we prospectively compared the safety and efficiency of HBH-HD with those of saline flushing HD (SF-HD) and HD using low dose heparin (LDH-HD) in 13 HD patients at risk of bleeding in a cross-over design. METHODS: The safety and efficiency were evaluated by measuring activated partial prothrombin time (aPTT) before and during HD, hemostasis time after needle removal, total blood compartment volume (TBCV) loss of dialyzer, urea clearance (K) and Kt/V. RESULTS: There was no difference in compression time needed to achieve hemostasis at puncture site after needle removal between HBH-HD, SF-HD and LDH-HD. During HBH-HD, there was a slight increase in aPTT at 15 min (50.6+/-4.5 sec), compared to predialysis levels (40.9+/-4.7 sec). In this cross- over study, aPTT during dialysis session was markedly higher in LDH-HD than those in HBH-HD or SF-HD (p<0.05). The loss of TBCV of the dialyzer was greater in SF-HD than HBH-HD or LDH-HD (17.4+/-1.9% vs. 12.4+/-1.4% vs. 10.1+/-1.8%). However, there was no difference in K (212.0+/-30.7 vs. 217.2+/-36.9 vs. 221.6+/- 29.5 mL/min) and Kt/V (1.22+/-0.12 vs. 1.24+/-0.16 vs. 1.26+/-0.18). CONCLUSION: We concluded that the safety and efficiency of HBH-HD are not different compared to SF-HD or LDH-HD and HBH-HD could an alternative hemodialysis method in patients at risk of bleeding.

Hemodialysis Using Heparin Bound Hemophan Hemodialysis in ESRD Patients at High Risk for Bleeding: A Seven-Year Experience / 대한신장학회잡지

OBJECTIVE: Positively charged N, N-diethyl-aminoehtyl groups on Hemophan enable negative charged heparin to be bound with the dialyzer membrane and hemodialysis using heparin bound Hemophan (HBH- HD) could be a hemodialysis modality in patients at risk of bleeding. We designed simplified heparin binding technique and evaluated the bleeding risk and efficiency of HBH-HD in chronic renal failure patients at risk of bleeding. METHODS: During the period from April 1995 through April 2002, 159 patients at high bleeding risk received 1057 HBH-HD (dialyzer: GFS plus 11, Gambro). The duration of each HBH-HD was standardized to 4 hours at blood-flow rate of 200-250 mL/min. To evaluate safety of HBH-HD, we measured serum heparin concentration (HC) and activated partial thromboplastin time (aPTT) at baseline, 15, 60, 120 minutes and endpoint (240 minutes) (n= 40). To evaluate the dialysis efficiency, HBH-HD and routine hemodialysis with systemic heparinization (R-HD) were compared for total blood compartment volume (TBCV) loss, dialyzer urea clearance (K) and Kt/V in same study group patients (n=20). RESULTS: Clotting of dialyzer necessitating termination of dialysis occurred in 11 (1.0%) out of 1, 057 dialyses at 150 minutes, and clotting requiring change of blood line occurred in 64 dialyses (6.1%) between 150 and 230 minutes. There was a slight increase in the aPTT (mean+/-SD, 49.8+/-10.5 sec) and HC (0.14+/-0.06 U/mL) at 15 min, compared to predialysis levels of 44.3+/-12.9 sec and 0.11+/-0.06 U/ mL, respectively (p>0.05). But no increase in aPTT, HC was observed in measurements at 60 min, 120 min, and at the endpoint. TBCV loss was significantly higher in HBH-HD (mean+/-SD, 17.2+/-9.6%), compared to R-HD (2.8+/-1.2%) (p0.05). CONCLUSION: HBH-HD could be a safe and efficient HD technique in patients at high risk of bleeding. Extracorporeal clotting, however, should be observed carefully during HBH-HD.

Comparison of Dialysis Efficiency Between Hemodialysis Using Heparin Bound Hemophan and Routine Hemodialysis with Systemic Heparinization / 대한신장학회잡지

Although hemodialysis using heparin bound Hemophan(HBH-HD) has been reported to be a possible modality that can be used in patients at high risk of bleeding, the efficiency of HBH-HD is not certain. To investigate the efficiency of HBH- HD, we compared the total blood compartment volume(TBCV), Kt/V and urea clearance of dialyzer(K) of HBH-HD with those of routine hemodialysis with systemic heparinization(R-HD) in the same patients. HBH-HD was switched to R-HD as soon as the bleeding risk had ceased. Before each HBH-HD, heparin solution(1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1 hour while removing saline solution(700ml/hr) by applying transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. Then we performed 10 HBH-HD on 10 patients at risk of bleeding. The dilayzer had to be changed due to severe clotting in one patient during HBH-HD so the comparison of above parameters was possible in 9 patients. The duration of each dialysis was possible in 9 patients. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. During HBH-HD, there was a slight increase in activated partial thromboplastin time(aPTT)(45.02.6 sec) at 15 min after initiation of dialysis from predialysis level (35.81.3 sec), but no increase in aPTT was observed at 60min, 120min, and the end of dialyses. The loss of TBCV(%) of dialyzers was greater in HBH-HD (174%) than in R-HD(51%). The Kt/V and K of HBH-HD, however, were 1.25+/-0.10 and 143+/-3ml/ min, respectively, which did not differ from those of R-HD which were 1.28+/-0.07 and 145+/-4ml/min, respectively. We conclude that the use of heparin bound Hemophan can be an efficient hemodialysis technique in patients at high risk of bleeding, but clotting of the dialyzer should be observed carefully during hemodialysis(values are mean+/-SE).

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

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.