Dialyzers Designed to Increase Internal Filtration Do Not Result in Significantly Increased Platelet Activation and Thrombin Generation

摘要

lntroduction:To increase middle molecule clearances, high-flux dialyzers with increased internal filtration have been developed. However, dialyzer design and structure may affect thrombin generation and platelet activation, thereby risking increased clotting and reduced dialyzer clearances. Methods: Coagulation parameters, platelet, white cell and endo-thelial activation markers were measured prior to and following dialysis sessions in 12 patients using two different dialyzers designed for increased internal filtration. Results: Prior to dialysis, patients had evidence of activation of coagulation with increased factor VllI:hC, thrombin-antithrom-bin complexes and prothrombin fragment 1+2, increased platelet activation, with raised platelet factor 4, beta-thrombo-globulin levels and increased fibrinolysis (raised D-dimers). Dialysis was associated with the release of soluble platelet integrin, sP selectin, increased endothelial activation with increased levels of von Willebrand factor (vWF) antigen (vWF:Ag) and vWF propeptide (vWF:pp) and sE selectin. There was no difference in tinzaparin levels at the end of the dialysis session using either dialyzer, as shown by anti-Xa activity - 0.145 +- 0.027 versus 0.11 +- 0.017 IU/ml, respectively.