Effect of vitamin-E-modified dialysers on dialyser clotting, erythropoietin and heparin dosage: A comparative crossover study

We performed a crossover study to compare the effects of different dialysis membranes on 20 patients with frequent dialyser clotting and requiring gre ater than or equal to5,000 units of heparin per dialysis session. Low-flux dialysers are C15NL (cellulose - Terumo) and E15NL (vitamin-E-coated - Teru mo) while high-flux dialysers were F60 (polysulphone) and EE15NL (vitamin-E -coated - Terumo). Ten patients underwent dialysis for 2 months with C15NL then switched to E15NL for 2 months. Similarly, the other 10 patients were started on the high-flux dialyser F60 and then switched over to EE15NL for 2 months. The following parameters were measured at the beginning of the st udy, 2 weeks, 1 month and then at 2 months: hemoglobin, prothrombin time (P T), partial thromboplastin time (PTT), fibrinogen, protein C, protein S, an tithrombin III (ATIII) and factor 12 activity. Dialyser clotting, heparin a nd erythropoietin requirements were assessed during each dialysis session. There was a significant reduction in clotting with E15NL in comparison to C 15NL (22.8 +/- 17 and 44.1 +/- 22.8 (p = 0.0233), respectively). Similarly, heparin requirements were less in the vitamin-E-coated (E15NL) dialysers, 4,754 +/- 1,427 vs. 6,011 +/- 856 units (p = 0.0281) and erythropoietin usa ge was also significantly reduced, 4,630 +/- 2,620 vs. 7,850 +/- 4,069 unit s (p = 0.049). There was a significant increase in hemoglobin with E15NL co mpared to C15NL, 115 +/- 10.4 vs. 108 +/- 13.1 (p = 0.0343). When the high- flux dialysers were compared there was a tendency towards less dialyser clo tting with the EE15NL compared to F60, though this did not achieve statisti cal significance (p = 0.0561). We could not demonstrate any significant cha nges between the different dialysers with regards to PT, PTT, fibrinogen fa ctor 12 activity, protein C, protein S and ATIII. In conclusion, we have sh own that the use of vitamin-E-modified dialysers is associated with less cl otting in patients with persistent clotting problems. In addition, this was associated with less heparin and erythropoietin requirements. Copyright (C ) 2000 S. Karger AG, Basel.