Nephrology Dialysis Transplantation, Vol 13, Issue 2 361-367, Copyright © 1998 by Oxford University Press
F Pizzarelli, T Cerrai, P Dattolo, C Tetta and Q Maggiore
Background. The introduction of techniques with
on-line (OL) production of replacement fluid by filtration of dialysis
fluid raises concerns about exposure of dialysis patients to pyrogenic
substances. This work was undertaken to evaluate safety and feasibility of
OL preparation of replacement fluid for haemodiafiltration (HDF).
Methods. OL HDF was carried out with commercially
available monitors without any adjustment in the operational organization
of our Centre. Bicarbonate dialysis fluid was filtered twice before being
reinjected into the patients. The effects of acute load of IL fluid were
assessed by very sensitive in vitro and in
vivo tests; the chronic effects were assessed by monitoring the
patients for the appearance of any untoward clinical manifestations and by
measuring their cytokine response. Results. In a pilot
study the membrane filter culture technique of replacement fluid yielded no
bacteria or mycetes growth, while LAL test was <0.01 EU/ml. The
normal human monocyte production of TNF&agr; IL-1{beta} and IL-1Ra
was not significantly different when cells were incubated with OL or
commercial replacement fluid. The patients' body temperature profile
(continuous recording during treatments and the following 24 h) overlapped
with that of the control procedure. Over 6 years we performed 4284 OL
treatments (total amount reinjected fluid 102 900 litres) on 13 patients
treated for 26±9 months. In none of these treatments did we
observe pyrogenic reactions. In comparison with the previous period on
standard bicarbonate haemodialysis, OL HDF afforded significantly better
cardiovascular tolerance to fluid removal and higher Kt/V values. The
nutritional status did not deteriorate, while the acute-phase reactants and
serum {beta}2M levels did not increase. Moreover, no translucent cysts
or destructive arthropathy were observed on bone X-rays. The patients'
plasma cytokine levels and monocytes cytokines production, measured either
before or after a single OL HDF, were comparable with the values obtained
in controls treated with standard HDF. Conclusions. We
conclude that OL-prepared replacement fluid is as safe as that of the
commercial bags with regard to sterility and non-pyrogenicity. OL-HDF can
be readily implemented in any dialysis centre without bringing any further
burden on the staff. Keywords: cytokines; endotoxins;
fever; on-line haemodiafiltration ; replacement fluid filtration
ORIGINAL ARTICLES
Convective treatments with on-line production of replacement fluid: a clinical experience lasting 6 years
Nephrology and Dialysis Unit, S.M. Annunziata Hospital, I-50011 Antella, Firenze, Italy; Clinical and Laboratory Research Department, Bellco, Mirandola, Italy; Corresponding author
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