NDT Advance Access published online on September 22, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn522
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Effective removal of protein-bound uraemic solutes by different convective strategies: a prospective trial
1 Renal Division, University Hospital Gent, Gent, Belgium 2 Gambro R&D, Lund, Sweden
Correspondence and offprint requests to: Correspondence and offprint requests to: Raymond Vanholder, Nephrology Section, 0K12, University Hospital, De Pintelaan, 185, B9000 Gent, Belgium. Tel: +32-9-3324525; Fax: +32-9-3324599; E-mail: Raymond.Vanholder{at}UGent.be
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Abstract |
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Background. Although different on-line convective removal strategies are available, there are no studies comparing the efficiency of solute removal for the three main options [post-dilution haemodiafiltration (post-HDF), pre-dilution haemodiafiltration (pre-HDF) and pre-dilution haemofiltration (pre-HF)] in parallel.
Methods. In this study, we compared post-HDF (Polyflux 170), pre-HDF (Polyflux 170) and pre-HF (Polyflux 210) in 14 patients. Parallelism of the evaluation protocols consisted in applying the same blood flow, dialysis time and effective convection (22.9 ± 1.7 versus 22.2 ± 2.0 L, P = NS) in pre-HDF versus post-HDF, and the same blood flow and dialysis time while comparing pre-HDF and pre-HF (1:1 dilution). With pre-HF, ultrafiltration was maximized and resulted in an effective convective volume of 28.5 L. We studied water-soluble compounds (urea, creatinine, uric acid), protein-bound compounds (hippuric acid, indole acetic acid, indoxylsulfate and p-cresylsulfate) and β2-microglobulin (β2M).
Results. Post-HDF was superior to pre-HDF for water-soluble compounds and β2M, whereas there was no difference for protein-bound compounds. Pre-HDF was superior to pre-HF for water-soluble compounds and protein-bound compounds. In contrast, removal of β2M for pre-HF was higher than for pre-HDF, but it did not differ from that obtained with post-HDF.
Conclusions. It is concluded that post-dilution is superior to pre-dilution HDF under conditions of similar convective volume, and that HDF is superior to HF in pre-dilution, with the exception of removal of β2M. Overall, post-HDF is the most efficient convective strategy among those tested.
Keywords: haemodiafiltration; haemofiltration; post-dilution; pre-dilution; uraemic toxins
Received for publication: 4. 4.08
Accepted in revised form: 25. 8.08
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