Nephrology Dialysis Transplantation, Vol 12, Issue 6 1182-1186, Copyright © 1997 by Oxford University Press
R Mactier, A Madi and B Allam
Background. Short-duration high-efficiency
haemodialysis has been utilized increasingly in recent years to deliver
adequate blood urea clearances per dialysis session. However,
high-efficiency and standard-duration haemodialysis schedules, which
achieve equal patient urea clearances, may not represent equivalent
dialytic therapy due to solute differences in intercompartmental
dysequilibrium during dialysis and differences in dialysis mechanics.
Methods. To circumvent the effects of
intercompartmental dysequilibrium and postdialysis rebound solute
clearances were measured by direct dialysis quantification (total and
partial dialysate collections) rather than blood clearances.
High-efficiency haemodialysis (dialyser blood flow rate=400 ml/min;
dialysis time=170.67 min) was compared with standard haemodialysis
(dialyser blood flow rate=200 ml/min; dialysis time=240 min) performed in
random order in six anuric patients using Fresenius F8 dialysers and the
same haemodialysis machine. Such haemodialysis schedules were prescribed to
provide equivalent urea clearances. Results. Patient
plasma water urea clearances measured by direct quantification were
equivalent, whereas high efficiency haemodialysis achieved significantly
lower phosphate clearances (P=0.01), less net
bicarbonate absorption (P=0.01), and
{beta}2microglobulin removal (P<0.001) than
standard haemodialysis. Estimated total dialysate effluent volumes with
partial dialysate collection and total dialysate collection correlated
closely (r=0.95) and there were no differences between
patient urea, creatinine and phosphate clearances measured by partial and
total dialysate quantification. Conclusions. The data
indicate that even if high-efficiency and standard haemodialysis provide
equal whole-body urea clearances, delivered dialysis therapy is not
equivalent. The partial dialysate collection method is as accurate as the
cumbersome total dialysate collection approach and may be applied to assess
delivered dose by minor modification of current haemodialysis machines.
Keywords: direct dialysis quantification;
high-efficiency haemodialysis; solute removal; urea kinetics; partial
dialysate collection; total dialysate collection
ORIGINAL ARTICLES
Comparison of high-efficiency and standard haemodialysis providing equal urea clearances by partial and total dialysate quantification
Renal Unit and Biochemistry Department, Stobhill Hospital, Balornock Road, Glasgow, UK; Corresponding author
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