Albumin Leakage in Online Hemodiafiltration, More Convective Transport, More Losses?

Abstract

Online hemodiafiltration (OL-HDF) has now demonstrated some benefits in reducing mortality. It seems that rising convective volumes improve the outcomes, but the risks of it, such as albumin leakage, are not well defined yet. The aim of the present study was to evaluate the albumin leakage using two different filters with 20 and 30 L of post-dilution OL-HDF. In this cross-sectional study, 20 prevalent patients receiving post-dilution OL-HDL were included. We analyzed two dialyzers: FX1000, FMC and Polyflux 210H, Gambro. During four consecutive dialysis sessions, monitors were programmed using control-volume to obtain 20 or 30 L with both dialyzers. We collected albumin samples of the effluent at 5, 15, 30, 45 and 60 min and performed area under the curve (AUC) determinations for evaluating the losses. Mean patient age was 60 ± 9 years, and 70% were men. Albumin leakage was significant higher with Polyflux 210H when compared to FX 1000 FMC. A convective volume of 30 L produced greater albumin leakage than 20 L with both filters, though only with the FX 1000 FMC was it significant (minimum albumin leakage during first hour with FX 1000 FMC 20 L: 79.2 [0.0-175.7] mg; 30 liters: 403.3 [63.5-960.7] mg; with PF 210 Gambro 20 L: 869.1 [420.0-3214.7] mg; 30 L: 1841.7 [443.8-3417.5] mg). During OL-HDF, convective transport causes albumin leakage at least during the first hour. The albumin concentration in the effluent differs according to the type of filter used and the convective volume.

Online Hemodiafiltration Reduces Bisphenol A Levels

“…The addition of a high level of convective transport to the classic diffusion model of hemodialysis allows for an enhanced clearance of middle molecules . However, in patients undergoing OL‐HDF, the impact of the reduction of middle molecules on prognosis still remains controversial, and some questions as the optimal convection volume or the importance of albumin leakage must be answered .…”

The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach

“…The diet-dialysis dyad is therefore modulated by dialysis prescriptions: On conventional thrice-weekly dialysis, dietary restrictions follow the need to maintain good metabolic balance (diet has to follow dialysis);On intensive dialysis schedules, higher efficiency and/or frequency may make an unrestricted diet possible (dialysis liberalizes diet);A particular case regards haemodiafiltration, in which high efficiency may be associated with significant protein loss, and the role of this loss in the context of dialysis-related malnutrition has still to be elucidated [94,95,96,97,98,99]. …”

“…A particular case regards haemodiafiltration, in which high efficiency may be associated with significant protein loss, and the role of this loss in the context of dialysis-related malnutrition has still to be elucidated [94,95,96,97,98,99]. …”

“…In fact protein loss via haemodialysis, is a problem that has been known since the early years of renal replacement therapy [37,38,39,40,96,97,98,99,157]. …”

Efficiency of post-dilution online hemodiafiltration therapy in combination with ketoanalogues of amino acid in the correction of protein-energy malnutrition in hemodialysis patients

“…Также в ряде работ показана возможность постдилюционной oнлайн-гемодиафильтрации значи-тельно снижать выраженность окислительного стресса, уровень маркеров эндотелиальной дисфункции, улучшать контроль анемии, что, в свою очередь, также способствует коррекции БЭН. К основным клиническим недостаткам постдилюционной oнлайн-гемодиафильтрации относят повышенную потерю в диализат альбумина, аминокислот, витамин, что значительно ухудшает нутриционный статус пациента и ведет к усугублению выраженности БЭН [11]. В связи с этим добавление в рацион пациента с адекват-ным уровнем потребления основных нутриентов (белок 1,1 г/кг идеальной массы тела/сутки) кетоаналогов амино-кислот в дозе 0,2 г/кг идеальной массы тела/сутки позво-ляет полностью нивелировать потерю белка и аминокис-лот в диализат при проведении постдилюционной онлайн-гемодиафильтрации, не приводя при этом к усилению выраженности гиперфосфатемии и метаболического аци-доза, как это происходит при увеличении потребления пищевого белка до 1,4 г/кг идеальной массы тела/сутки за счет обычного рациона.…”