Boone, Matthieu

Dhondt, Annemieke

Dierick, Manuel

Eloot, Sunny

Van Biesen, Wim

Vanommeslaeghe, Floris

Ghent University Academic Bibliography

FP455 HAEMODIALYSER FIBER BLOCKING: THE INNER COUNTSFloris Vanommeslaeghe2, Wim Van Biesen2, Manuel Dierick1, Matthieu Boone1,Annemie Dhondt2, Sunny Eloot21Centre for X-ray Tomography, Physics and Astronomy, Ghent University, Gent, Belgiumand 2Nephrology, Ghent University Hospital, Gent, BelgiumINTRODUCTIONANDAIMS:Coagulation in the haemodialysis (HD) circuitdecreases treatment efficiency and can result in substantial blood loss. So far,multiple surrogate markers are used during or after haemodialysis, to estimate theactivation of coagulation. None of these tools is able to quantify fiber patency inthe entire dialyser, and validation against a gold standard is lacking. Being able toobjectively determine the number of patent fibers would overcome this importantbarrier in comparative studies in different dialysers and different anticoagulationstrategies. We therefore developed a novel technique based onmicro-CT scanningto quantify coagulation in fibers of haemodialysers. To illustrate the potential ofthis technique, different machine parameters and visual scoring were evaluatedduring HD.METHODS: Twenty stable HD patients were treated with post dilution haemodiafil-tration for 245620min with an FX600 haemodialyser on a 5008 dialysis machine(both Fresenius, Germany) using lowmolecular weight heparin anticoagulationaccording to body weight. Every 30min, ultrafiltration and substitution flows and vol-umes, venous and arterial pressure, transmembrane pressure, blood volumemonitor-ing and online clearance monitoring, all as indicated by the machine, were registered.After dialysis, haemodialyser and venous chamber and line were scored with colourcoding, and clot sizes were visually estimated. Next, in an in vitro setting, continuousmild positive pressure ventilation was applied in the dialyser for 24h after which dialy-ser dry mass was measured. The 20 used and 3 fresh non-used dialysers were, as a goldstandard, scanned (resolution 25mm) in HECTOR (an in-house developed High-Energy CT scanner Optimised for Research). After image reconstruction, the open,non-coagulated fibers were counted in a representative cross-section at the dialyseroutlet (ImageJ, Fiji).RESULTS: In non-used versus used FX600 dialysers, 1074862 versus 893062465[range 534-10692] open fibers were counted, witnessing the very high accuracy of themethod. In used dialysers, the number of open fibers did not correlate with any of themeasured machine parameters. Furthermore, the associations with the visual scoring ofthe dialyser (R2¼0.41) and venous chamber (R2¼0.34), and with the post-dialysis dial-yser dry mass (R2¼0.62) substantially suffered from disappointing point prevalencepredictive power, making these parameters unreliable at the level of the individualpatient.CONCLUSIONS:Although an important issue in clinical practice, dialysis machinesdo not provide any online parameter to accurately predict fiber blocking in haemodial-ysis. The described micro-CT scanning technique is a feasible, objective, non-invasive,accurate and reproducible tool for quantification of the degree of fiber blocking in ahaemodialyser after use, making it a potential gold standard for use in studies on fiberblocking during renal replacement therapy.Nephrology Dialysis Transplantation Abstractsdoi:10.1093/ndt/gfy104 | i189Downloaded from https://academic.oup.com/ndt/article-abstract/33/suppl_1/i189/4997558by Ghent University useron 20 July 2018

Haemodialiser fiber blocking : the inner counts

https://biblio.ugent.be/publication/8569322/file/8569323

Haemodialiser fiber blocking : the inner counts

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Ghent University Academic Bibliography