Clinical perspectives of on-line haemodiafiltration (original) (raw)
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).
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.
Achieving High Convective Volumes in On-Line Hemodiafiltration
Blood Purification, 2013
Current Status of On-Line Hemodiafiltration as a Renal Replacement Therapy Other than in the USA, OL-HDF has established itself in routine clinical practice, with widespread application of this modality particularly in Europe and Japan. In fact, in Western Europe, OL-HDF has even surpassed peritoneal dialysis as the preferred renal replacement therapy (RRT) option; about 18% of the HD patients in 2011 were treated with OL-HDF in this region. Ever since OL-HDF became available in 1985 when cheap, highly pure and unlimited amounts of substitution fluids (made possible by cold sterilization filtration technology) could be produced 'on-line', the prescription of OL-HDF has risen steadily [1]. It is important to reiterate that the appeal of OL-HDF is attributed, in the first place, to the recognition that larger uremic retention solutes need to be efficiently removed to combat the effects of uremia [2]. An extensive clinical experience has shown that OL-HDF alleviates an impressive list of conditions that are associated with CKD or linked to the dialysis procedure. Additionally, recent clinical evidence indicates reduced mortality for patients treated with OL-HDF [3-5] .
Hemodiafiltration: Technical and Medical Insights
Bioengineering
Despite the significant medical and technical improvements in the field of dialytic renal replacement modalities, morbidity and mortality are excessively high among patients with end-stage kidney disease, and most interventional studies yielded disappointing results. Hemodiafiltration, a dialysis method that was implemented in clinics many years ago and that combines the two main principles of hemodialysis and hemofiltration—diffusion and convection—has had a positive impact on mortality rates, especially when delivered in a high-volume mode as a surrogate for a high convective dose. The achievement of high substitution volumes during dialysis treatments does not only depend on patient characteristics but also on the dialyzer (membrane) and the adequately equipped hemodiafiltration machine. The present review article summarizes the technical aspects of online hemodiafiltration and discusses present and ongoing clinical studies with regards to hard clinical and patient-reported outco...
Haemodialyser reuse: facts and fiction
Nephrology Dialysis Transplantation, 2000
85-102 21. Estacio R, Jeffers B, Hiatt W, Schrier R. The effect of nisoldipine 15. World Health Organization ( WHO), International Society of as compared with enalapril on cardiovascular events in patients Hypertension. Blood pressure lowering treatment trial collaborawith NIDD and hypertension. N Engl J Med 1998; 338: 645-652 tion. Protocol of blood pressure lowering treatments. J Hypertens 22. Tuomilehto J, Rastenyte D, Birkenhäger W, for the SYST-EUR 1998; 16: 127-137 trial investigators: Effect of calcium channel blockade in older 16. Neal B, MacMahon S. On behalf of the PROGRESS managepatients with diabetes and systolic hypertension. N Engl J Med ment committee. The PROGRESS study: rationale and design. 1999; 340: 677-684 with high-flux dialysers increased from 0.2% in 1993, to
Haemodiafiltration: Present time technical, clinical, and financial issues
portuguese journal of nephrology and hypertension, 2015
Online haemodiafiltration (HDF) is not a generic term that covers all convection-based renal replacement modalities – an optimal convection dose must be delivered to improve outcomes of end-stage kidney disease patients. In this brief article, we review current facts on HDF technical features, clinical/ biological effects, and financial issues. In summary, HDF today offers highly efficient solute removal over the to-date widest known uraemic toxin molecular weight spectrum. Both safety and efficacy have been demonstrated in several shortand medium-term clinical studies. Recent randomized controled clinical trials and systematic reviews accredited the superiority of online HDF over standard haemodialysis (HD) when adequate convection dose is delivered. Additional clinical trials are needed to establish the optimal convection dose for different clinical settings (e.g. different patient characteristics and/or ethnicities, different substitution fluid delivery modalities) and to establi...