Platelet activation and clotting cascade activation by dialyzers designed for high volume online hemodiafiltration

Introduction: Hemodialysis patients are pro‐thrombotic. Higher volume online postdilutional hemodiafiltration (OL‐HDF), with increasing hematocrit increases the risk of clotting in the extracorporeal circuit (ECC). We wished to determine whether OL‐HDF increased platelet activation and ECC clotting. Methods: Coagulation parameters, platelet, white cell, and endothelial activation markers were measured at the start and end of dialysis sessions in 10 patients and also pre‐ and post‐dialyzer after 15 minutes using two different dialyzers designed for high volume OL‐HDF; cellulose triacetate (TAGP) and polysulphone (PS), and polyvinylpyrrolidone (PVP). Patients were anticoagulated with a heparin bolus. Findings: At the start of OL‐HDF, D dimers, thrombin antithrombin complexes (TATs), and soluble adhesions molecules (sICAM‐1 and sVCAM‐1) were increased. Post‐treatment soluble P selectin (PS/PVP 26.7 ± 7.1 versus 36.6 ± 9.9; TAGP 28.7 ± 7.2 versus 43.5 ± 8.4 ng/ml, P