Please select the eligibility criteria that correspond to the clinical trial below.
Title: Evaluation of Contact Phase Activation During Hemodialysis Using Different Dialysis Membranes: a Prospective Randomized Crossover Study
Brief Summary: Every patient included in the study will undergo 3 standardised hemodialysis treatments, each using a different dialysis membrane (PMMA, PS, AN69ST). The order of the membranes used will be randomized.

During each conventional and standardised hemodialysis treatment, 6 blood samples will be taken at different time points (T0, T5, T15, T30, T90, T240) to evaluate coagulation activation (TAT, PF1+2, d-dimers, TF) and, more specifically, activation of the contact phase pathway of coagulation (kallikrein, fXIa, fXIIa).


Options:
A: Inclusion Criteria:

* Patients requiring heparin free dialysis treatments on nephrologists' prescription,
* Chronic ESRD patients treated by maintenance hemodialysis for at least 3 months,
* Patients with a well functioning blood access that can allow a blood flow of at least 250 ml/min,
* Patients aged 18 years or more,
* Written consent to participate in the study (informed consent).

Exclusion Criteria:

* Patients in ICU settings,
* AKI patients,
* Patients dialyzed in self care, satellite HD units,
* Patients treated in single needle mode,
* Known heparin contraindication (HIT type II),
* Patients requiring blood and other labile blood products (i.e. fresh frozen plasma, platelets, etc ...) transfusion during hemodialysis treatment,
* Patients receiving oral anticoagulants (including Anti vitamin K),
* Patients receiving a combination of anti-platelets agents,
* Patients treated with unfractionated or low molecular weight heparin beside the dialysis treatment to prevent deep vein thrombosis,
* Pregnant/ planning pregnancy and lactating women during study period,
* Adult patients protected by the law,
* Patients are not affiliated to health insurance system (beneficiary or dependant)
* Participation in other interventional studies during the study period,
* Patients that have already been included in this study.
B: Inclusion Criteria:

* Patients treated with hemodialysis or hemodiafiltration since at least three months.
* Hemodialysis or hemodiafiltration prescription of 3 x 4 hours weekly.
* ≥ 18 years of age.
* Patients able and agree to provide signed informed consent.

Exclusion Criteria:

* Contraindication to heparin defined as known heparin-induced thrombopenia or active bleeding risk with contra-indication for systemic anticoagulation, categorized as defined by Swartz and Port1.
* Planned surgery during study period, including scheduled living-donor kidney transplantation during study period.
* Hypercoagulable state defined as known malignancy, known APC resistance/FV Leiden, known prothrombin gene mutation, known protein C or protein S deficiency, known antithrombin deficiency.
* Mean Qb of \<300ml/min during one of the last 3 dialysis sessions before inclusion.
* 1 or more results of spKt/Vurea \< 1,35 during the last three months prior to study inclusion.
* Need for 2 or more supplementary dialysis sessions on top of the regular 3x4 hours weekly hemodialysis regimen during the last month before inclusion.
* Vascular access dysfunction defined as

  1. use of urokinase the 2 months before study inclusion, including to restore catheter permeability.
  2. non-tunneled hemodialysis catheter use.
  3. known AV access outflow tract stenosis.
  4. planned vascular access intervention.
  5. planned vascular access conversion.
* Known allergy against heparin grafted AN69STmembranes.
* Use of ACE-inhibitor
* Use of vitamin K antagonist
* Use of novel oral anticoagulant therapy.
* Any medical condition, which puts the patient at risk of premature study termination in the opinion of the investigator.
* Planned conversion of dialysis modality during study period or planned absence/leave (including pregnancy or planned pregnancy).
* Symptomatic hypocalcemia.
* Hb \< 8g/dl at screening.
* Hct \> 45% at screening.
* Perdialytic total parenteral nutrition therapy
C: Inclusion Criteria:

* Males and females, age at least 18 years, or the local age of consent, whichever is greater.
* Patients with AF defined as AF on ECG at enrollment or two or more reports of AF from separate monitoring events at least 2 weeks apart (report of ECG, Holter monitor, event monitor or implantable loop recorder).
* CHA2DS2-VASc score of ≥ 2.
* End-stage renal disease treated with hemodialysis for ≥ 3 months.
* Considered by the treating physician(s) to be candidate for oral anticoagulation.
* If of childbearing potential, be willing to avoid pregnancy during the study.

Exclusion Criteria:

* Not considered by the treating physician(s) to be candidates for oral anticoagulation (for example, hemoglobin \< 8.5g/dL, history of intracranial hemorrhage, active bleeding, recent gastrointestinal bleed or retroperitoneal bleed, severe hepatic impairment, or anaphylactic reaction to apixaban)
* Moderate or severe mitral stenosis
* Conditions other than AF that require anticoagulation such as mechanical prosthetic valve, deep venous thrombosis, or pulmonary embolism
* Need for aspirin at a dose \> 81 mg a day or need for P2Y12 antagonist therapy (for example clopidogrel, prasugrel, or ticagrelor)
* Life expectancy \< 3 months
* Anticipated kidney transplant within the next 3 months
* Prisoners or others who are involuntarily incarcerated or detained
* Pregnant, breastfeeding, or considering pregnancy.
* Participation in a clinical trial of an experimental treatment within the past 30 days
D: Inclusion Criteria:

* Patients treated with hemodialysis since at least three months.
* Hemodialysis treatment schedule of 3 x 4 hours weekly.
* Arteriovenous fistula (AVF) use for vascular access.
* Treatment with oral acetylsalicylic acid 80 or 100mg q every day.
* ≥ 18 years of age.
* Patients able and agree to provide signed informed consent.

Exclusion Criteria:

* Use of vitamin K antagonists or novel oral anticoagulant therapy.
* Use of chronic heparin treatment, UFH or LMWH.
* Use of clopidogrel.
* Use of ACE-inhibitors.
* Known allergy against one of the dialysis membranes used during this study (PMMA: BKU®, Toray; PS: Phylter®, Bellco; AN69ST: Evodial®, Gambro).
* Known heparin-induced trombopenia type 2.
* Active infection and/or ongoing systemic antimicrobial treatment.
* Presence of central venous catheter, tunnelled or non-tunnelled and/or AV graft.
* Hospitalized patients.
* Planned surgery during study period.
* Mean Qb of \<300ml/min during one of the last 3 dialysis sessions before inclusion.
* Vascular access dysfunction defined as (a) known AV access outflow tract stenosis, (b) planned vascular access intervention, (c) planned vascular access conversion.
* Planned conversion of dialysis modality during study period.

Answer: D