A Clinical Evaluation of Large‐area Short‐time Haemodialysis

Abstract

A large-area short-time (LAST) haemodialysis regimen (three hours by three times per week on a 2-5 M2 haemodialyser) has been compared with conventional haemodialysis (six hours by three times per week on a 1-3 M2 haemodialyser) on four patients over a period of eight months. Parameters monitored throughout the study included: Serum biochemistries, haematocrit, extra-cellular fluid space, platelet function, granulocyte kinetics, immunological status and neurological status. All patients showed weight increases (3--12%) during the LAST dialysis period. These increases were related to problems of intradialytic hypotension which resulted from the increased rate of fluid removal required during the LAST dialysis period. Hypotension was not a problem during routine dialysis all patients showed an increase of 10--20% (P less than 0-05) in predialysis serum urea and creatinine and a moderate decrease in predialysis serum bicarbonate (from 24-8 +/- 2-2 to 21-4 +/- 2-6 mM/I, P less than 0-005). This study indicates that, providing fluid balance can be controlled, a LAST dialysis regimen provides comparable therapy to conventional haemodialysis. However, recent studies have suggested that short-time dialysis may be possible with conventional 1-0 to 1-3 M2 haemodialysers, indicating that short-time haemodialysis may not need to involve more costly large-area haemodialysers.

Dialysis time: does it matter? A reappraisal of existing literature

“…Nearly all of the publications espoused the virtues of efficient, short hemodialyses [9][10][11][12][13]. A few indicated potential limitations of the therapy due to hypotension, neuropathy, and potential difficulties in fluid removal, but were mostly tempered by cautious optimism [14][15][16][17]. These small studies were controversial and led to the National Institutes of Health (NIH)-funded National Cooperative Purpose of review The length of time (T d ) required for adequate maintenance hemodialysis therapy is perceived as a substantial patient burden.…”

Renal Handling of Uremic Middle Molecules

“…The middle molecule (MM) hypothesis [I], which pos tulates that many of the manifestations associated with uremia may result from the retention of intermediate mo lecular weight metabolites (300-2,000 daltons), has greatly influenced the treatment of chronic renal failure [2], The MM hypothesis has been directly responsible for altering dialysis regimens [3] and design of dialyzers [4] and the development of dialysis membranes [5] which facilitate the removal of MM species during dialytic therapy. Elevated levels of endogenous MM substances have been isolated from uremic body fluids [6][7][8], but their compositions and roles in uremic toxicity have yet to be established [2], Fi'irst et al [7], using a two-stage chromatographic separation, have quantitated uremic MM fractions which were found to be elevated in uremic patients with such clinical com plications as pericarditis and neuropathy and were found to be low in patients without complications [9], These frac tions are believed to contain peptide materials based on amino acid analyses before and al ter acid hydrolysis.…”