Hemodiafiltration outcomes in special situations

Golper, Thomas A.

doi:10.1111/sdi.13074

Cited by 2 publications

(2 citation statements)

References 31 publications

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“…Therefore, it should be considered the preferred technique in this clinical context without specific indications for individual patients, although benefits in specific subgroups still need to be explored. While the long-term benefits seem to be more evident in younger patients with a better nutritional status and lower cardiovascular burden [ 170 ], short-term benefits and symptom relief may be more relevant in groups with higher comorbidity [ 171 ].…”

Section: Discussionmentioning

confidence: 99%

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

Pedreros-Rosales,

Jara,

Lorca

et al. 2023

Toxins

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Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients.

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Section: Discussionmentioning

confidence: 99%

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

Pedreros-Rosales,

Jara,

Lorca

et al. 2023

Toxins

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“…Such registries can overcome the statistical limitations and provide strong data to orient the clinicians to the most optimized therapeutic approaches based on the patients profiles and prognosis. Finally, with the newer expanded dialytic therapies like hemodiafiltration [ 80 ] or the expanded hemodialysis with medium cutoff membranes [ 81 ] dialyzers, we expect an even better treatment outcomes for calciphylaxis [ 82 ].…”

Section: Study Limitations Conclusion and Perspectivesmentioning

confidence: 99%

Multimodality approach to treat calciphylaxis in end-stage kidney disease patients

Lajoie,

Ghanemi,

Bourbeau

et al. 2023

Renal Failure

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A multimodality approach has been proposed as an effective treatment for calciphylaxis in patients with end-stage kidney disease. In this retrospective study, we report the cases of 12 end-stage kidney disease patients from l’Hôtel-Dieu de Québec hospital (Canada) who were diagnosed with calciphylaxis between 2004 and 2012 and treated with a multimodality clinical approach including sodium thiosulfate (STS). Statistical analyses were performed to evaluate the impacts of patients characteristics, the different interventions as well as therapy regimen on the therapeutic response. The majority of patients ( n = 9) were hemodialyzed. The patients-associated comorbidities were consistent with previously reported risk factors for calciphylaxis: Diabetes ( n = 11), calcium-based phosphate binders use ( n = 10), warfarin use ( n = 9), obesity ( n = 7), female gender ( n = 8) and intravenous iron use ( n = 8). STS was given for a median duration of 81 days. 75% of the patients had a response (total or partial) including a complete response in 42% of patients. One-year mortality rate was low (25%). STS was used during a mean duration of 83.33 ± 41.52 days and with a total cumulating dose of 1129.00 ± 490.58 g. The recorded mean time before a complete response was 102.20 days (51–143). Pain improvement occurred after a mean time of 8.67 ± 10.06 days. None of the studied factors was statistically associated with a complete or a partial response to the multimodality approach. Although our data have a limited statistical power, they support treating calciphylaxis with a multimodality approach including STS as its effects are independent from important clinical variables.

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Hemodiafiltration outcomes in special situations

Cited by 2 publications

References 31 publications

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

Multimodality approach to treat calciphylaxis in end-stage kidney disease patients

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