Hemodialysis Using Heparin-Bound Hemophan in Patients at Risk of Bleeding

• Published in: Nephron Vol. 97; no. 1; p. c5
• Main Authors: Kyu-Beck, Lee, Kim, Beom, Yoon-Ha, Lee, Soo-Jin, Yoon, Woo-Hun Kang, Huh, Wooseong, Dae-Joong, Kim, Ha-Young, Oh, Yoon-Goo, Kim
• Format: Journal Article
• Language: English
• Published: Basel S. Karger AG 01.05.2004
• ISSN: 1660-8151; 2235-3186

Background/Aims: Since heparin can bind to Hemophan, hemodialysis using heparin-bound Hemophan (HBH-HD) could be a useful modality in patients at risk of bleeding. We designed a simplified heparin binding technique and assessed the safety and efficiency of HBH-HD. Methods: To bind heparin to Hemophan, heparin solution (1 liter, 20 IU/ml saline) was recirculated through Hemophan (GFS plus 11, Gambro) for 1 h while the saline solution (700 ml/h) was removed. In 28 maintenance dialysis patients at risk of bleeding, we evaluated the heparin concentration (HC) and activated partial thromboplastin time (aPTT) during HBH-HD to assess the increased risk of bleeding. We compared the safety and efficiency of HBH-HD with that of routine hemodialysis with low-dose heparinization (R-HD) in a prospective cross-over study, and then analyzed the outcomes of 1,057 HBH-HD in 159 patients. Results: During HBH-HD, there was a slight increase in both HC (0.15 ± 0.03 IU/ml, p < 0.01) and aPTT (43.7 ± 5.7 s, p < 0.01) at 15 min after the initiation of dialysis compared to predialysis levels (0.11 ± 0.03 IU/ml and 37.5 ± 6.3 s). However, there was no increase in HC and aPTT at 60 min, 120 min and at the end of dialysis. In a cross-over study, aPTT during dialysis was markedly lower in HBH-HD than in R-HD (p < 0.01). The Kt/V (1.22 ± 0.31, p > 0.05) and urea clearance (136 ± 17 ml/min, p > 0.05) of HBH-HD did not significantly differ from those of R-HD (1.29 ± 0.57 and 136 ± 13 ml/min). However, the loss of total blood compartment volume of the dialyzer was greater in HBH-HD (17.5 ± 9.2%, p < 0.01) than in R-HD (2.9 ± 1.2%). Out of 1,057 HBH-HD, 982 HBH-HD (93%) were successfully completed while 75 HBH-HD (7%) resulted in severe clotting. Conclusion: We conclude that the HBH-HD could minimize the bleeding risk and be an efficient HD technique in patients at high risk of bleeding. Careful observation for extracorporeal clotting is, however, required during HBH-HD. Copyright © 2004 S. Karger AG, Basel