Hemodialysis or Hemofiltration - the Patients’ View

Hüfler, M.; Asmus, G.; Herrath, D. von; Schaefer, K.

doi:10.1159/000169449

Cited by 11 publications

(7 citation statements)

References 4 publications

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“…The com bined use of a high convective transport rate and a membrane with a low intrinsic C5a generation rate may be responsible for the greater apparent biocompatibility attributed to hemofiltration than to conventional he modialysis, as evidenced, for example, by a strong preference of patients for hemofiltra tion over hemodialysis [192] because of re duced acute complications, and by substan tially reduced incidence of febrile reactions [193]. These two observations may reflect a lower concentration of C5a in the blood leaving the dialyzer and a lower burden of monocyte-derived IL-1.…”

Section: Effect O F Ultrafiltrationmentioning

confidence: 99%

Analysis of Membrane Processes for Blood Purification

Colton

1987

Blood Purif

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Physical phenomena play an important role in membrane processes for blood purification. They largely determine the separation performance of these devices and they interact with chemical and biological phenomena to determine their biocompatibility, or lack thereof, in the clinical setting. In the first part of this paper, analyses of physical phenomena which determine the separation and purification characteristics are reviewed for several processes, including hemodialysis, hemofiltration, combined hemodialysis and ultra-filtration, and membrane plasmapheresis with cross-flow microfiltration. Special attention is given to transport of high-molecular weight solutes in hemodialysis, for use in subsequent analyses, and to the factors which determine filtrate flux in membrane plasmapheresis, because recent findings in this area provide an understanding of filtration processes in general. The second part concerns the problem of biocompatibility, especially as manifested in renal prostheses. After reviewing some of the pathways to bioincompatibility, exploratory analyses are presented using relatively simple models. The objective of these analyses is to provide an initial quantitative framework for examining the likelihood of monocyte secretion of interleukin-1 being stimulated by various routes. Issues examined, for which illustrative calculations are presented, include (1) transport of endotoxin fragments across regenerated cellulose and other membranes, (2) anaphylatoxin C5a concentrations in conventional hemodialysis and (3) the effects of equilibrium and reaction phenomena, ultrafiltration, diffusive membrane permeation and membrane adsorption on the disposition of C5a which is generated at the membrane surface.

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Section: Effect O F Ultrafiltrationmentioning

confidence: 99%

Analysis of Membrane Processes for Blood Purification

Colton

1987

Blood Purif

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“…Several benefits of hemofiltration (HF) over hemodialysis (HD), for example better cardiovascular stability [1][2][3], lower morbidi ty [4,5], higher survival rate in high-risk patients [6,7] and better removal of high molecular weight metabolites such as (T-microglobulin [8,9], have been well documented in the literature. In spite of this HF is used only to a limited extent.…”

Section: Introductionmentioning

confidence: 99%

On-Line Predilution Hemofiltration versus Ultrapure High-Flux Hemodialysis: A Multicenter Prospective Study in 23 Patients

Altieri¹,

Sorba

Bolasco³

et al. 1997

Blood Purif

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The aims of the present prospective multicenter study were to assess the clinical tolerance and well being, the correlation between nPCr and Kt/V and the pretreatment β₂-microglobulin level in patients sequentially treated with high-flux dialysis with ultrapure bicarbonate hemodialysis (HD; phase I) and predilution hemofiltration (HF) with on-line prepared bicarbonate substitution fluid (phase II). The same monitor (Gambro AK 100 ULTRA®) and membrane (polyamide) were used. Twenty-three patients, all in a stable clinical condition, entered the study. The treatment was targeted to an equilibrated Kt/V (eqKt/V) of 1.4 for HD and 1.0 for HF. No mortality or relevant morbidity were observed. The number of hypotensive episodes was 1.78 ± 2.8 per patient and month during HD vs. 1.17 ± 3.1 during HF (p = 0.003) and the number of the hypertensive episodes 1.28 ± 2.8 during HD vs. 0.42 ± 0.8 during HF (p = 0.04). Incidences of arrhythmia, muscular cramps and headache were significantly less frequent during HF. Interdialytic cramps, arthralgia and fatigue were also significantly less frequent during the HF period. The average β₂-microglobulin level was 27.1 ± 14.7 mg/dl at the start of the study, 22.9 ± 4.9 mg/dl at the beginning of phase II and 22.4 ± 4 mg/dl at the end of phase II (p = 0.01 compared to the start). A significant linear correlation between the normalized protein catabolic rate and eqKt/V was obtained faster during HD than during HF (45 vs. 120 days) indicating that HF affects the nutritional status with mechanisms different from HD. The present study is in agreement with the hypothesis that HF gives an adequate nutritional status with improved clinical stability and well being at a lower Kt/V compared to HD. Both therapies were efficient in controlling the pretreatment β₂-microglobulin level.

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“…Thrice weekly hemofiltration, compared to hemodialysis, has been associated with fewer symptoms both during and after treatment. Twenty of 26 (76.9%) patients with ESRD who had experienced both treatment modalities preferred hemofiltration 41 . Ninety percent stated they would remain on hemofiltration even if they had to increase their treatment time by 1 hr!…”

Section: Advantages Of Hemofiltrationmentioning

confidence: 99%

Hemofiltration as a treatment for end‐stage renal disease

Zimmerman

2004

Hemodialysis International

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Patients treated for end-stage renal disease (ESRD) have a poorer quality of life and a higher mortality rate than patients in the general population. In addition, the cost to provide ESRD care is tremendous. Daily hemodialysis programs have been associated with improvements in the patient's quality of life, anemia management, blood pressure, nutrition, and left ventricular hypertrophy. In addition, especially when treated at home, cost savings are possible. Daily hemofiltration may offer additional benefits with enhanced middle-molecule clearance, improved cardiovascular stability, and perhaps a further reduction in cost. Finally, ease of use of the NxStage System One may encourage patients to undergo their treatment at home.

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Hemodialysis or Hemofiltration - the Patients’ View

Cited by 11 publications

References 4 publications

Analysis of Membrane Processes for Blood Purification

Analysis of Membrane Processes for Blood Purification

On-Line Predilution Hemofiltration versus Ultrapure High-Flux Hemodialysis: A Multicenter Prospective Study in 23 Patients

Hemofiltration as a treatment for end‐stage renal disease

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