Haemodiafiltration with sorbent-regenerated ultrafiltrate as replacement fluid: a multicenter study

Abstract

Reinfusion of ultrafiltrate through an uncoated charcoal cartridge proved to be a safe, well-tolerated and simple technique. Further potential benefits of regenerated ultrafiltrate may also include the maintenance of acid-base balance with reinfusion of endogenous bicarbonate.

Phosphate control in dialysis

“…19,20 Since the end of the 1990s, a new hemodialytic method was introduced that employed three types of depuration: convection; adsorption by resins; and diffusion. 21 An ultrafiltrate is formed by the plasma water leaving the convective filter, and it is conveyed into a cartridge containing adsorbents (polystyrenic resin), which retain various high molecular-weight toxic substances. In the last step, the further purified plasma water goes into the diffusive filter.…”

In vivo Removal of High- and Low-Molecular-Weight Compounds in Hemodiafiltration with On-Line Regeneration of Ultrafiltrate

“…In the context of various hemodiafiltration techniques, paired filtration dialysis-charcoal was initially used to regenerate the ultrafiltrate in order to produce a bacteria- and endotoxin-free replacement fluid [17]. In contrast to other on-line HDF techniques, HFR also offers the advantage of having no external source of endotoxin or bacterial contamination (since the reinfusion is regenerated from the patients own ultrafiltrate).…”

“…Derived from the original concept of paired filtration dialysis, hemodiafiltration with on-line regeneration of ultrafiltrate is a new integrated two-step sorbent system combining the advantages derived from the use of a double-chamber hemodiafiltration system and of regenerated ultrafiltrate as an endogenous substitution fluid [17,18,19]. The aim of this study was to evaluate the impact of hemodiafiltration with on-line regeneration of the ultrafiltrate (HFR on-line) on the in vivo removal of a wide spectrum of uremic toxins with different molecular weights.…”

Pulse Push/Pull Hemodialysis: Convective Renal Replacement Therapy

“…In addition, since small molecules that are not captured by the adsorbent can be removed by diffusion at the hemodialyzer, the regenerated ultrafiltrate is successfully applied as replacement fluid (Sanz-Moreno & Botella, 1995). Trace elements, such as manganese, selenium, arsenic, cadmium, mercury, lead, chromium, and zinc, also remain unaltered after passing through the adsorbent column, whereas copper is completely retained by the charcoal (de Francisco et al, 1997). Adsorption capacities were further increased by combining hydrophobic styrenic resin along with uncoated charcoal, because the resin has a high binding affinity for several mid molecular weight species, such as, 2M (Marinez de Francisco et al, 2000) and homocysteine (Splendiani et al, 2004), or free immunoglobulin light chains (Testa et al, 2010).…”

“…Adsorption capacities were further increased by combining hydrophobic styrenic resin along with uncoated charcoal, because the resin has a high binding affinity for several mid molecular weight species, such as, 2M (Marinez de Francisco et al, 2000) and homocysteine (Splendiani et al, 2004), or free immunoglobulin light chains (Testa et al, 2010). The other benefits of this regenerated ultrafiltrate include a better acid-base balance due to the reinfusion of endogenous bicarbonate (de Francisco et al, 1997), and also the not inconsiderable advantage of combining high convection without compromising physiologic molecule loss. Ultrafiltrate has a composition similar to that of plasma and contains huge numbers of polypeptides and other beneficial substances, such as, hormones, amino acids, and vitamins (Weissinger et al, 2004), and ultrafiltrate regeneration allows these beneficial nutrients to be reinfused (La Greca et al, 1998).…”