Optimizar la hemodiálisisAnticoagulación del circuito extracorpóreo y elección del dializador

Resumo

Patients on hemodialysis have high rates of morbidity and mortality, due to the retention of various uremic toxins. Post-dilution online hemodiafiltration with a high replacement volume has shown improvements in survival compared with conventional hemodialysis. However, the purifying effect of the dialyzer itself has not been studied in depth, and it remains unknown whether the type of dialyzer could have additional benefits to the applied dialysis technique.During hemodialysis, contact between blood and the components of the extracorporeal circuit activates the coagulation cascade and leads to the deposition of fibrin and platelets, which can reduce the purifying efficacy. Therefore, anticoagulation is essential to guarantee the quality of dialysis. However, it is unknown whether the effect of low-molecular-weight heparin varies depending on the route of administration or the hemodialysis technique used.Different aspects, as detailed subsequently, were proposed for optimizing anticoagulation of the extracorporeal circuit with low molecular weight heparin and the choice of dialyzer.The purifying effect of the dialyzer using different membranes: Hemodialysis parameters, including infusion volume, were standardized. The first hypothesis is that the type of membrane used influences the efficacy of uremic toxin clearance and albumin loss. Two studies were proposed to test this hypothesis: in the first, different dialyzers with synthetic membranes were used. In the second, a cellulose membrane that has recently appeared on the market—asymmetric cellulose triacetate—was used...