Effects of different dialysis membranes on serum concentrations of epoetin alfa, darbepoetin alfa, enoxaparin, and iron sucrose during dialysis

Abstract

Background: Numerous substances are administered during dialysis for anticoagulation and the treatment of anemia and iron deficiency. The availability of current dialysis membranes is diverse, but assessment of the effects of different membranes on these routinely administered substances is lacking. This prospective study appraises specific effects of 7 dialysis membranes (4 low-flux membranes, 3 high-flux membranes) on the handling of 4 commonly administered agents (epoetin alfa, darbepoetin alfa, enoxaparin, and iron sucrose) during dialysis.

Methods: Using a different membrane sequentially, 6 stable hemodialysis patients were treated with epoetin alfa, enoxaparin, and iron sucrose, and 6 patients with darbepoetin alfa. Serum concentrations (predialyzer and postdialyzer) of each substance were assessed after administration and after 4 hours of dialysis (predialyzer).

Results: Overall, use of low-flux membranes resulted in similar serum concentrations for all compounds. However, use of high-flux membranes showed reduced antifactor Xa levels immediately (predialyzer, P = 0.028; postdialyzer, P = 0.027) and 4 hours after (P = 0.001) administration of enoxaparin compared with low-flux membranes. Variable changes in darbepoetin concentrations also were found between the high-flux membranes during dialysis (P = 0.009). Although peak serum concentrations of all compounds were inversely proportional to body weight, the percentage of change during dialysis was not related to dosage or body weight.

Conclusion: High-flux membranes may require greater doses of enoxaparin to ensure adequate anticoagulation during dialysis and may be associated with variable changes in darbepoetin concentrations. For other compounds, no noteworthy difference among membranes was defined.