Nephrology Dialysis Transplantation, Vol 14, Issue 5 1202-1207, Copyright © 1999 by Oxford University Press
F Maduell, C del Pozo, H Garcia, L Sanchez, J Hdez-Jaras, M Albero, C Calvo, I Torregrosa and V Navarro
Background. On-line haemodiafiltration (HDF) is a
technique which combines diffusion with elevated convection and uses
pyrogen-free dialysate as a replacement fluid. The purpose of this study
was to evaluate the difference between conventional HDF (1-3 l/h) and
on-line HDF (6-12 l/h). Methods. The study included 37
patients, 25 males and 12 females. The mean age was 56.5±13
years and duration of dialysis was 62.7±49 months. Three
patients dropped out for transplantation, three patients died and three
failed to complete the study period. Initially all patients were on
conventional HDF with high-flux membranes over the preceding
34±32 months. Treatment was performed with blood flow (QB)
402±41 ml/min, dialysis time (Td) 187 min, dialysate flow (QD)
654±126 ml/min and replacement fluid (Qi) 4.0±2
l/session. Patients were changed to on-line HDF with the same filter and
dialysis time, QD 679±38 ml/min (NS), QB 434±68
ml/min (P<0.05) and post-dilutional replacement
fluid 22.5±4.3 l/session (P<0.001).
We compared conventional HDF with on-line HDF over a period of 1 year.
Dialysis adequacy was monitored according to standard Clinical and
biochemical criteria. Kinetic analysis of urea and
{beta}2-micro-globulin ({beta}2m) was performed monthly.
Results. Tolerance was excellent and no pyrogenic
reactions were observed. Pre-dialysis sodium increased 2 mEq/l during
on-line HDF. Plasma potassium, pre- and post-dialysis bicarbonate, uric
acid, phosphate, calcium, iPTH, albumin, total proteins, cholesterol and
triglycerides remained stable. The mean plasma {beta}2m reduction ratio
increased from 56.1±8.7% in conventional HDF to
71.1±9.1% in on-line HDF (P<0.001).
The pre-dialysis plasma {beta}2m decreased from 27.4±8.1 to
24.2±6.5 mg/l (P<0.01). Mean Kt/V
(Daugirdas 2nd generation) was 1.35±0.21 in conventional HDF
compared with 1.56±0.29 in on-line HDF
(P<0.01), Kt/Vr (Kt/V taking into consideration
post-dialysis urea rebound) 1.12±0.17 vs
1.26±0.20 (P<0.01), BUN time average
concentration (TAC) 44.4±9 vs
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 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%),
P<0.05, during the on-line HDF period, which
allowed a decrease in the erythropoietin doses (3861±2446
vs 3232±2492 UI/week),
(P<0.05). Better blood pressure control (MAP
103.8±15 vs 97.8±11 mmHg,
P<0.01) and a lower percentage of patients
requiring antihypertensive drugs were also observed. Conclusion.
The change from conventional HDF to on-line HDF results in
increased convective removal and fluid replacement (18 l/session). During
on-line HDF treatment, dialysis dose was increased for both small and large
molecules with a decrease in uraemic toxicity level (TAC). On-line HDF
provided a better correction of anaemia with lower dosages of
erythropoietin. Finally, blood pressure was easily controlled.
Keywords: adequate dialysis; convection; conventional
haemodialfiltration; on-line haemodiafiltration
ORIGINAL ARTICLES
Change from conventional haemodiafiltration to on-line haemodiafiltration
Nephrology Department, Hospital Virgen de los Lirios, Alcoy, Spain; Hospital General de Castelló, Av. Benicasim s/n, E-12004 Castellón, Spain; Corresponding author
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