Clinical perspectives of on-line haemodiafiltration (original) (raw)
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On-line haemodiafiltration: state of the art
Nephrology Dialysis Transplantation, 1998
Faced with the shortcomings of conventional and routinely performed treatment modality for enddialysis on a long-term basis, as illustrated by the stage renal failure ( ESRF ) patients. Long-term dialysis dialysis-related pathology, a need for a new strategy is a basic therapeutic option in the armamentorium of exists to improve the overall quality of treatment in the nephrologist: in many instances, it is by necessity end-stage renal failure ( ESRF ) patients. On-line an alternative to renal transplant. On the other hand, haemodiafiltration (HDF ) seems to be the best therait must be remembered that any dialysis modality, peutic option to achieve this goal at the present time. regardless of performance and efficacy, will only par-By enhancing convective clearances through highly tially and periodically restore the composition of the permeable membranes, HDF offers the greatest solute internal milieu of the ESRF patient. Despite such a fluxes both for low and higher molecular weight limitation, RRT is presently supporting the life of uraemic toxins. As for example, in our routinely perabout one million patients worldwide. formed HDF programme based on 3 weekly sessions
Mid-dilution on-line haemodiafiltration in a standard dialyser configuration
Nephrology Dialysis Transplantation, 2005
Background. Mid-dilution haemodiafiltration (HDF) results in an improved middle molecule removal compared with standard HDF. The OLp u ur TM MD 190 haemodiafilter represents a new dialyser design exclusively for mid-dilution on-line HDF. Compared with standard haemodialysers, structural changes in the headers allow the infusion of high replacement fluid volumes after a first post-dilution and before a second pre-dilution stage. Methods. We compared in vitro the new device [blood flow (Q B ) 400 ml/min, substitution flow (Q S ) 100 and 200 ml/min, dialysate flow (Q D ) 800 ml/min] with a conventional high-flux dialyser of the same surface area in haemodialysis (HD) (Q D 500 ml/min) and postdilution HDF (at Q S 60, Q D ¼ 500 ml/min and at Q S 100, Q D ¼ 800 ml/min) modes. Subsequently, we performed an initial clinical application of the new device in six mid-dilution HDF treatments of five end-stage renal disease patients (Q B 400 ml/min, Q S 200 ml/min, Q D 800 ml/min, treatment duration 205±23 min). Results. In vitro urea and b 2 -microglobulin clearances in mid-dilution HDF were, respectively, 309.2±5.5 and 144.4±15.2 ml/min (Q S 100) and 321.6±4.1 and 204.9±4.1 ml/min (Q S 200), compared with 278.6± 17.2 and 94.0±7.6 ml/min in HD, and 310.8±10.2 and 123.0±6.5 ml/min (Q S 60) and 323.6±11.2 and 158.0±10.3 ml/min (Q S 100) in post-dilution HDF. The in vivo trials showed the clinical utility of the device and confirmed the in vitro data: urea and b 2 -microglobulin clearances were, respectively, 324.6± 10.9 and 207.9±29.3 ml/min, while reduction ratios were 75.0±5.5 and 83.6±4.7%. Conclusion. Our preliminary results need confirmation in a prospective cross-over study. However, the Nephros MD 190 haemodiafilter promises to be a true technological step ahead in terms of improved b 2 -microglobulin removal.
Change from conventional haemodiafiltration to on-line haemodiafiltration
urea rebound ) 1.12±0.17 vs 1.26±0.20 (P <0.01), BUN time average concentration ( TAC ) 44.4±9 vs Background. On-line haemodiafiltration (HDF ) is a technique which combines diffusion with elevated con-40.6±10 mg/dl (P <0.05) and protein catabolic rate (PCR) 1.13±0.22 vs 1.13±0.24 g/kg (NS). There was vection and uses pyrogen-free dialysate as a replacement fluid. The purpose of this study was to evaluate a significant increase in haemoglobin (10.66±1.1 vs 11.4±1.5) and haematocrit (32.2±2.9 vs 34.0±4.4%), the difference between conventional HDF (1-3 l/h) and on-line HDF (6-12 l/h). P <0.05, during the on-line HDF period, which allowed a decrease in the erythropoietin doses Methods. The study included 37 patients, 25 males and 12 females. The mean age was 56.5±13 years and (3861±2446 vs 3232±2492 UI/week), (P <0.05).
Optimization of mid-dilution haemodiafiltration: technique and performance
Nephrology Dialysis Transplantation, 2009
Background. Mid-dilution haemodiafiltration (MD-HDF), reported as a highly efficient convective-mixed technique, has demonstrated serious drawbacks in relation to the high pressure originating inside the blood compartment of the filter during clinical application. This randomized crossover design study was planned to optimize the efficiency of the MD-HDF technique while reducing its inherent risks. Methods. Fifteen patients on RRT were submitted in random sequence to standard and reverse MD-HDF under sim-ilar operating conditions. Efficiency in solute removal was evaluated by measuring urea (U), phosphate (P) and beta2microglobulin (β2-m), mean dialysate clearances (K DQ ) and eKt/V. Blood and dialysate compartment pressures were monitored on-line during the sessions, and instantaneous hydraulic and membrane permeability indexes were calculated.
Nephrology Dialysis Transplantation, 2007
Background. Improvement in the uraemic toxicity profile obtained with the application of convective and mixed dialysis techniques has stimulated the development of more efficient strategies. Our study was a prospective randomized evaluation of the clinical and technical characteristics of two new haemodiafiltration (HDF) strategies, mixed HDF and mid-dilution HDF, which have recently been proposed with the aim of increasing efficiency and safety with respect to the standard traditional HDF infusion modes.
Haemodiafiltration--optimal efficiency and safety
Clinical Kidney Journal, 2009
Haemodiafiltration (HDF) is the blood purification therapy of choice for those who want significant removal of uraemic solutes beyond the traditional range of small molecules. Combining diffusive and convective solute transport, a HDF treatment comprises the largest number of variables among blood purification therapies, and it is important to understand how they interact in order to optimize the therapy. This review discusses the parameters that determine the efficiency of HDF and how they can be controlled in the different forms of HDF and 'HDF-like' therapies practised today. The key to safe and effective HDF therapy is to have access to large volumes of high-quality fluids. Starting with ultrapure dialysis fluid, on-line preparation of a sterile, nonpyrogenic substitution solution can be made an integral part of the treatment, and we describe the necessary conditions for this. On-line HDF can provide the largest removal of the widest range of solutes among available dialysis therapies, and the potential clinical benefits of this are within practical reach for the increasing number of patients dialysed with high-flux membranes and ultrapure dialysis fluid.
Mid-dilution on-line hemodiafiltration: technology and efficiency outcome
Background: The standard pre-and post-dilution methods of fluid substitution in on-line hemodiafiltration (OL-HDF) have limitations in removal of uremic toxins. Objective: To review the technique and efficiency outcomes of mid-dilution OL-HDF. Results: Mid-dilution OL-HDF could provide comparable or better efficiency with pre-and post-dilution modes. There are no serious adverse effects or technical complications. Conclusion: It appears that mid-dilution OL-HDF could combine the advantages and overcome the disadvantages of pre-and post-dilution modes.