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Introducción: La reciente aparición de membranas de corte medio ofrece una alternativa para la eliminación de moléculas medianas y nueva terapia dialítica, la hemodiálisis expandida. Estas membranas se caracterizan por un mayor tamaño de poro que podría afectar a la eliminación de la heparina utilizada durante las sesiones de hemodiálisis.
Objetivo: Determinar si existen diferencias en la necesidad de heparina y el estado de coagulación del sistema y dializador según técnica dialítica empleada.
Material y Método: Estudio cuasiexperimental en pacientes en hemodiálisis con dos periodos de estudio, en el primero, el paciente realizó hemodiálisis convencional o hemodiafiltración y en el segundo, hemodiálisis expandida con membranas de corte medio.
Resultados: El dializador quedó parcialmente coagulado en el 10,3% de las sesiones de hemodiálisis expandida frente al 19,1% de las sesiones de hemodiálisis y el 11,4% de hemodiafiltración (p=0,011).
Conclusiones: La hemodiálisis expandida ofrece mejor estado de coagulación final del sistema y dializador que otras membranas.
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Derechos de autor 2021 Raquel Pelayo-Alonso, José Luis Cobo-Sánchez, Patricia Patricia Martínez-Álvarez, Marta Portilla-Sánc
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
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© Los autores ceden de forma no exclusiva los derechos de explotación de los trabajos publicados y consiente en que su uso y distribución se realice con la Licencia Creative Commons Atribución - No comercial 4.0 Internacional (CC BY-NC 4.0). Puede consultar desde aquí la versión informativa y el texto legal de la licencia. Esta circunstancia ha de hacerse constar expresamente de esta forma cuando sea necesario.
Referencias
- Weiner D, Falzon L, Skoufus L, Bernando A, Beck W et al. Efficacy and Safety of Expanded Hemodialysis with the Theranova 400 Dialyzer. A Randomized Controlled Trial. CJASN 2020;15(9):1310-9. DOI: https://doi.org/10.2215/CJN.01210120
- Cozzolino M, Magagnoli L, Ciceri P, Conte F, Galassi A. Effects of a medium cut-off (Theranova®) dialyser on haemodialysis patients: a prospective cross over study. Clin Kidney J 2021;14(1):382-9. DOI: https://doi.org/10.1093/ckj/sfz155
- García A, Vega A, Linares T, Abad S, Macías N et al. Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration. Clin Kidney J 2018; 11(5):742-6. DOI: https://doi.org/10.1093/ckj/sfy004
- Lim JH, Jeon Y, Yook JM, Choi SY, Jung HY et al. Medium cut-off dialyzer improves erythropoiesis stimulating agent resistance in a hepcidin-independent manner in maintenance hemodialysis patients: results from a randomized controlled trial. Sci Rep 2020; 10:16062. DOI: https://doi.org/10.1038/s41598-020-73124-x
- Bunch A, Sánchez R, Nilsson LG, Bernardo AA, Vesga JI et al. Medium cut-off dialyzers in a large population of hemodialysis in Colombia: COREXH registry. Ther Apher Dial 2021;25:33-43. DOI: https://doi.org/10.1111/1744-9987.13506
- Alarcón JC, Bunch A, Ardila F, Zuñiga E, Vesga JI et al. Impact of Medium Cut-Off Dialyzers on Patient-Reported Outcomes: COREXH Registry. Blood Purif 2021;50:110-8. DOI: https://doi.org/10.1159/000508803
- Cho NJ, Park S, Islam MI, Song HY, Lee EY, Gil HW. Long-term effect of medium cut-off dialyzer on middle uremic toxins and cell-free hemoglobin. PLoS ONE 2019; 14(7): e0220448. DOI: https://doi.org/10.1371/journal.pone.0220448
- Cozzolino M, Ronco C. Medium Cut-Off Membranes: Incremental Quantum Leap Innovation in Haemodialysis? Blood Purif 2021;50:449-52. DOI: https://doi.org/10.1159/000512537
- Kim TH, Kim SH, Kim TY , Yeul PH, Jung KS et al. Removal of large middle molecules via haemodialysis with medium cut-off membranes at lower blood flow rates: an observational prospective study. BMC Nephrol 2020;21:2. DOI: https://doi.org/10.1186/s12882-019-1669-3
- Lim JH, Park Y, Yook JM, Choi SY, Jung HY et al. Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients. Sci Rep 2020;10:7780. DOI: https://doi.org/10.1038/s41598-020-64622-z
- Ronco C, Marchionna N, Brendolan A, Neri M, Lorenzin A et al. Expanded haemodialysis: from operational mechanism to clinical results. Nephrol Dial Transplant 2018;33:41-7. DOI: https://doi.org/10.1093/ndt/gfy202
- Zweigart C, Boschetti A, Hulko A, Nilsson LG, Beck W et al. Medium cut-off membranes - closer to the natural kidney removal function. Int J Artif Organs 2017;40(7):328-34.13. DOI: https://doi.org/10.5301/ijao.5000603
- Santos A, Macías N, Vega A, Abad S, Linares T et al. Expanded hemodialysis: Is anticoagulation of the dialysis circuit different from online hemodiafiltration and high-flux hemodialysis? Ther Apher Dial 2021;1-7. DOI: https://doi.org/10.1111/1744-9987.13652
- Herrero-Calvo J. Nefrología al día. Anticoagulación en Hemodiálisis. [Internet] (Consultado 20 mar 2021) Disponible en: https://www.nefrologiaaldia.org/312.
- Heyne N. Expanded hemodialysis therapy: prescription and delivery. Contrib Nephrol 2017;191:153-7. DOI: https://doi.org/10.1159/000479263
- Florens N, Juillard L. Expanded haemodialysis: news from the field. Nephrol Dial Transplant 2018; 33:48-52. DOI: https://doi.org/10.1093/ndt/gfy203
- Voigt M, Gebert M, Haug U, Hulko M, Storr M et al. Retention of beneficial molecules and coagulation factors during haemodialysis and haemodiafiltration. Sci Rep 2019;9:6370. DOI: https://doi.org/10.1038/s41598-019-42783-w
- Santos A, Macías N, Vega A, Abad S, Linares T et al. Efficacy of enoxaparin in preventing coagulation during high-flux haemodialysis, expanded haemodialysis and haemodiafiltration. Clin Kidney J2021;14(4):1120-5. DOI: https://doi.org/10.1093/ckj/sfaa057
- Kessler M, Gangemi C, Gutierrez Martones A, Lacombe JL, Krier-Coudert MJ, Galland R et al. Heparin-grafted dialysis membrane allows minimal systemic anticoagulation in regular hemodialysis patients: a prospective proof-of-concept study. Hemodial Int. 2013;17(2):282-93. DOI: https://doi.org/10.1111/j.1542-4758.2012.00733.x
- Morena M, Jaussent I, Chalabi L, Bargnoux AS, Dupuy AM, Badiou S et al. Biocompatibility of heparin-grafted hemodialysis membranes: impact on monocyte chemoattractant protein-1 circulating level and oxidative status. Hemodial Int. 2010;14(4):403-10. DOI: https://doi.org/10.1111/j.1542-4758.2010.00494.x
- Frascà GM, Sagripanti S, D'Arezzo M, Oliva S, Francioso A, Mosconi G et al. Post-dilution hemodiafiltration with a heparin-grafted polyacrylonitrile membrane. Ther Apher Dial. 2015;19(2):154-61. 22. Herrero JA, González E, Pérez R, Tornero F. Estudio español sobre anticoagulación en hemodiálisis. Nefrología 2012;32(2):143-52. DOI: https://doi.org/10.1111/1744-9987.12230
Referencias
Weiner D, Falzon L, Skoufus L, Bernando A, Beck W et al. Efficacy and Safety of Expanded Hemodialysis with the Theranova 400 Dialyzer. A Randomized Controlled Trial. CJASN 2020;15(9):1310-9. DOI: https://doi.org/10.2215/CJN.01210120
Cozzolino M, Magagnoli L, Ciceri P, Conte F, Galassi A. Effects of a medium cut-off (Theranova®) dialyser on haemodialysis patients: a prospective cross over study. Clin Kidney J 2021;14(1):382-9. DOI: https://doi.org/10.1093/ckj/sfz155
García A, Vega A, Linares T, Abad S, Macías N et al. Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration. Clin Kidney J 2018; 11(5):742-6. DOI: https://doi.org/10.1093/ckj/sfy004
Lim JH, Jeon Y, Yook JM, Choi SY, Jung HY et al. Medium cut-off dialyzer improves erythropoiesis stimulating agent resistance in a hepcidin-independent manner in maintenance hemodialysis patients: results from a randomized controlled trial. Sci Rep 2020; 10:16062. DOI: https://doi.org/10.1038/s41598-020-73124-x
Bunch A, Sánchez R, Nilsson LG, Bernardo AA, Vesga JI et al. Medium cut-off dialyzers in a large population of hemodialysis in Colombia: COREXH registry. Ther Apher Dial 2021;25:33-43. DOI: https://doi.org/10.1111/1744-9987.13506
Alarcón JC, Bunch A, Ardila F, Zuñiga E, Vesga JI et al. Impact of Medium Cut-Off Dialyzers on Patient-Reported Outcomes: COREXH Registry. Blood Purif 2021;50:110-8. DOI: https://doi.org/10.1159/000508803
Cho NJ, Park S, Islam MI, Song HY, Lee EY, Gil HW. Long-term effect of medium cut-off dialyzer on middle uremic toxins and cell-free hemoglobin. PLoS ONE 2019; 14(7): e0220448. DOI: https://doi.org/10.1371/journal.pone.0220448
Cozzolino M, Ronco C. Medium Cut-Off Membranes: Incremental Quantum Leap Innovation in Haemodialysis? Blood Purif 2021;50:449-52. DOI: https://doi.org/10.1159/000512537
Kim TH, Kim SH, Kim TY , Yeul PH, Jung KS et al. Removal of large middle molecules via haemodialysis with medium cut-off membranes at lower blood flow rates: an observational prospective study. BMC Nephrol 2020;21:2. DOI: https://doi.org/10.1186/s12882-019-1669-3
Lim JH, Park Y, Yook JM, Choi SY, Jung HY et al. Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients. Sci Rep 2020;10:7780. DOI: https://doi.org/10.1038/s41598-020-64622-z
Ronco C, Marchionna N, Brendolan A, Neri M, Lorenzin A et al. Expanded haemodialysis: from operational mechanism to clinical results. Nephrol Dial Transplant 2018;33:41-7. DOI: https://doi.org/10.1093/ndt/gfy202
Zweigart C, Boschetti A, Hulko A, Nilsson LG, Beck W et al. Medium cut-off membranes - closer to the natural kidney removal function. Int J Artif Organs 2017;40(7):328-34.13. DOI: https://doi.org/10.5301/ijao.5000603
Santos A, Macías N, Vega A, Abad S, Linares T et al. Expanded hemodialysis: Is anticoagulation of the dialysis circuit different from online hemodiafiltration and high-flux hemodialysis? Ther Apher Dial 2021;1-7. DOI: https://doi.org/10.1111/1744-9987.13652
Herrero-Calvo J. Nefrología al día. Anticoagulación en Hemodiálisis. [Internet] (Consultado 20 mar 2021) Disponible en: https://www.nefrologiaaldia.org/312.
Heyne N. Expanded hemodialysis therapy: prescription and delivery. Contrib Nephrol 2017;191:153-7. DOI: https://doi.org/10.1159/000479263
Florens N, Juillard L. Expanded haemodialysis: news from the field. Nephrol Dial Transplant 2018; 33:48-52. DOI: https://doi.org/10.1093/ndt/gfy203
Voigt M, Gebert M, Haug U, Hulko M, Storr M et al. Retention of beneficial molecules and coagulation factors during haemodialysis and haemodiafiltration. Sci Rep 2019;9:6370. DOI: https://doi.org/10.1038/s41598-019-42783-w
Santos A, Macías N, Vega A, Abad S, Linares T et al. Efficacy of enoxaparin in preventing coagulation during high-flux haemodialysis, expanded haemodialysis and haemodiafiltration. Clin Kidney J2021;14(4):1120-5. DOI: https://doi.org/10.1093/ckj/sfaa057
Kessler M, Gangemi C, Gutierrez Martones A, Lacombe JL, Krier-Coudert MJ, Galland R et al. Heparin-grafted dialysis membrane allows minimal systemic anticoagulation in regular hemodialysis patients: a prospective proof-of-concept study. Hemodial Int. 2013;17(2):282-93. DOI: https://doi.org/10.1111/j.1542-4758.2012.00733.x
Morena M, Jaussent I, Chalabi L, Bargnoux AS, Dupuy AM, Badiou S et al. Biocompatibility of heparin-grafted hemodialysis membranes: impact on monocyte chemoattractant protein-1 circulating level and oxidative status. Hemodial Int. 2010;14(4):403-10. DOI: https://doi.org/10.1111/j.1542-4758.2010.00494.x
Frascà GM, Sagripanti S, D'Arezzo M, Oliva S, Francioso A, Mosconi G et al. Post-dilution hemodiafiltration with a heparin-grafted polyacrylonitrile membrane. Ther Apher Dial. 2015;19(2):154-61. 22. Herrero JA, González E, Pérez R, Tornero F. Estudio español sobre anticoagulación en hemodiálisis. Nefrología 2012;32(2):143-52. DOI: https://doi.org/10.1111/1744-9987.12230