Hemodiafiltration Using Dialysate as Substitution Fluid

Canaud, Bernard; Nguyen, Quang-Linh; Argilés, Àngel; Polito, Cesare; Polascheoo, H. D.; Mion, C

doi:10.1111/j.1525-1594.1987.tb02655.x

Cited by 18 publications

(9 citation statements)

References 2 publications

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“…In 1983, Shaldon et al developed an in‐line hemofiltration system (13). This system is a single patient dialysis machine with a water treatment system and pyrogen cut filters (14,15). In Japan, on‐line hemofiltration began to be performed clinically in 1992 as HDF that allows large volume exchange and has been established as the so‐called central on‐line HDF system (8).…”

Section: Discussionmentioning

confidence: 99%

On‐Line Hemodiafiltration in Critical Care

Kawanishi

2002

Therapeutic Apheresis

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On-line products of substitution fluid permits virtually unlimited fluid volume exchange during continuous hemodiafiltration (CHDF) to critical care. In on-line hemodiafiltration (HDF), endotoxin free dialysate obtained using pyrogen cut filters is infused into the blood circuit, and HDF is automatically performed using the closed-loop balancing system of the dialysis machine. Online CHDF is the application of this on-line HDF to con-tinuous renal replacement therapy in the critical care field. We performed on-line CHDF on 376 acute renal failure patients during a 5 year period, and the mean survival rate was 62.5%. We concluded that the on-line CHDF system is safe and effective at maintaining acute renal failure patients.

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Section: Discussionmentioning

confidence: 99%

On‐Line Hemodiafiltration in Critical Care

Kawanishi

2002

Therapeutic Apheresis

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“…The incorporation of the online HDF (ol-HDF) module into the dialysis proportioning machine hardware is benefi cial: fi rst, it simplifi es the handling procedure compared to bag use; second, it secures the process by enslaving the infusion module to the safety regulation of the HDF monitor; third, it permits to check regularly the physical integrity of the ultrafi lters by means of a built-in air pressure test [14]. This technically advantageous and cost-competitive production of substitution fl uid has been employed to develop various forms of high-effi ciency HDF modalities (postdilution, predilution, mixed-dilution, middilution).…”

Section: Rationale For Online Hemodiafiltrationmentioning

confidence: 99%

Online Hemodiafiltration

Canaud

2007

Hemodiafiltration

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Online production of substitution fluid by 'cold sterilization' (ultrafiltration) of dialysis fluid gives access to virtually unlimited amounts of sterile and nonpyrogenic solution. The incorporation of the online hemodiafiltration (ol-HDF) module into the dialysis proportioning machine hardware simplifies the handling procedure, secures the process by keeping the safety regulation of the monitor and offers virtually unlimited amounts of sterile and nonpyrogenic substitutive solution. The safety of the ol-HDF relies upon use of ultrapure water and strict and permanent highly hygienic rules of use. The use of a specifically designed certified HDF machine is also mandatory. Several forms of ol-HDF have been developed and used to cover specific clinical needs of chronic kidney disease patients. Conventional ol-HDF are classified according to the mode of substitution as post-, pre- and mixed dilution. Alternative-based ol-HDF incorporate push/pull HDF, double high-flux HDF, paired HDF and middilution HDF. A very simple description of these methods is provided in this section. Best clinical practices are summarized in this section to optimize performances of ol-HDF and maximize the safety of the method. It is noteworthy to stress the important role of blood flow, fluid volume exchange, hemodiafilter performances and duration of sessions in the overall treatment efficacy. It is also crucial to insist on the importance of strict hygienic handling, microbiology monitoring and the quality assurance process to ensure the safety of the method. In addition, ol-HDF offers the best technical platform to develop new therapeutic strategies such as daily treatment, total automation of priming and cleansing procedures and biofeedback volume control.

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“…Implementing ol-HDF module onto the hemodialysis machine has several advantages: it simplifies the handling procedure for nursing staff and technician; it secures the technical process by coupling the infusion/ultrafiltration module to the safety monitoring of the ol-HDF machine, and it permits online ultrafilter integrity monitoring by pressure test [13]. ol-HDF provides a multipurpose platform that permits to develop and customize ol-HDF options (HDF with post-, pre-mixed, and mid-dilution) to patient's metabolic needs and hemorheologic conditions [14][15][16][17].…”

mentioning

confidence: 99%

Optimal Therapeutic Conditions for Online Hemodiafiltration

Canaud¹,

Chénine²,

Renaud³

et al. 2010

Contributions to Nephrology

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The safety of online hemodiafiltration (ol-HDF) relies on very strict rules of use. The use of ultrapure water to feed an ol-HDF machine is a basic requirement for ol-HDF. Technical aspects and microbial monitoring have been precisely described in the European Best Practice Guidelines. Specifically designed and certified ol-HDF machines are needed. All these machines share the production of substitution fluid by the cold sterilization process of fresh dialysate based on ultrafilters. Hygiene handling is a crucial measure to ensure permanent safety of the ol-HDF system. Frequent disinfection of the water treatment system and dialysis machine, destruction of biofilm by chemical agents and/or thermochemical disinfection, change of filters at regular intervals, and maintenance of a permanent circulation of water are among the basic measures required to ensure ultra-purity of water and dialysis fluid. Optimal performances of ol-HDF require the use of high blood flow (300-400 ml/min), highly permeable and adequately sized hemodiafilters, a high volume of substitution (5-6 l/h) and high dialysate flow (500 ml/min). The site and type of substitution (pre-, post-, mixed, and mid-dilution) should be customized to each patient according to its blood hemorheology and its filtration fraction limitation (transmembrane pressure). All attempts should be made to maximize the fluid volume exchange per session (convective dose) in any cases. The treatment schedule in terms of session duration and weekly frequency need to be adjusted individually to improve hemodynamic tolerance, to facilitate correction of fluid overload and to increase dialysis dose (for middle-sized solutes) in order to reduce circulating levels of major uremic toxins. ol-HDF is the more advanced form of renal replacement therapy offering high efficiency over a large spectrum of toxins, high biocompatibility profile and high flexible modality. ol-HDF may help to improve global care of chronic kidney disease patients and may be considered the renal replacement therapy of the future.

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Hemodiafiltration Using Dialysate as Substitution Fluid

Cited by 18 publications

References 2 publications

On‐Line Hemodiafiltration in Critical Care

On‐Line Hemodiafiltration in Critical Care

Online Hemodiafiltration

Optimal Therapeutic Conditions for Online Hemodiafiltration

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