Improvement of Anemia in Patients on Chronic Dialysis Treated by Hemodiafiltration

Gonella, M.; Pratesi, G; Calabrese, G.; Vagelli, G; Mazzotta, A

doi:10.1159/000169591

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Plasma β 2 M levels are further reduced in on‐line hemodiafiltration versus high‐flux HD (120,127,134). Uncontrolled studies reported significant improvement in hemoglobin level and a reduced need for erythropoietin in patients using on‐line hemodiafiltration (135–137), possibly as a result of the increased removal of middle molecular inhibitors of erythropoiesis (138).…”

Section: Future Perspectivesmentioning

confidence: 99%

Reviews: Uremic Toxins: A New Focus on an Old Subject

Yavuz

Tetta

Ersoy

et al. 2005

Seminars in Dialysis

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The uremic syndrome is characterized by an accumulation of uremic toxins due to inadequate kidney function. The European Uremic Toxin (EUTox) Work Group has listed 90 compounds considered to be uremic toxins. Sixty-eight have a molecular weight less than 500 Da, 12 exceed 12,000 Da, and 10 have a molecular weight between 500 and 12,000 Da. Twenty-five solutes (28%) are protein bound. The kinetics of urea removal is not representative of other molecules such as protein-bound solutes or the middle molecules, making Kt/V misleading. Clearances of urea, even in well-dialyzed patients, amount to only one-sixth of physiological clearance. In contrast to native kidney function, the removal of uremic toxins in dialysis is achieved by a one-step membrane-based process and is intermittent. The resulting sawtooth plasma concentrations of uremic toxins contrast with the continuous function of native kidneys, which provides constant solute clearances and mass removal rates. Our increasing knowledge of uremic toxins will help guide future treatment strategies to remove them.

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Section: Future Perspectivesmentioning

confidence: 99%

Reviews: Uremic Toxins: A New Focus on an Old Subject

Yavuz

Tetta

Ersoy

et al. 2005

Seminars in Dialysis

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“…Towards the end of the 1980s, Gonella et al [1] demonstrated a significant improvement in anemia during HDF compared to bicarbonate hemodialysis (BHD), correlated with improved clearance efficiency as a result of higher convective flows, irrespective of the duration of dialysis session. Subsequently, numerous literature reports have confirmed the erythropoiesis-stimulating effects produced through the use of methods implying a large convective component [2,3,4,5,6,7,8,9,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Hemodiafiltration with Endogenous Reinfusion with and without Acetate-Free Dialysis Solutions: Effect on ESA Requirement

Bolasco¹,

Ghezzi

Serra³

et al. 2011

Blood Purif

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Background: Hemofiltrate reinfusion (HFR) is a form of hemodiafiltration (HDF) in which replacement fluid is constituted by ultrafiltrate from the patient ‘regenerated’ through a cartridge containing hydrophobic styrene resin. Bicarbonate-based dialysis solutions (DS) used in routine hemodialysis and HDF contain small quantities of acetate (3–5 mM) as a stabilizing agent, one of the major causes of intradialytic hypotension. Acetate-free (AF) DS have recently been made available, substituting acetate with hydrochloric acid. The impact of AF DS during HFR on Hb levels and erythropoietic-stimulating agent (ESA) requirement in chronic dialysis patients was assessed. Patients and Methods: After obtaining informed consent, 30 uremic patients treated by standard bicarbonate dialysis (BHD, DS with acetate) were randomized to treatment in 3-month cycles: first AF HFR, followed by HFR with acetate, and again AF HFR. At the beginning and end of each period, Hb and ESA requirements were evaluated. Results: A significant increase in the Hb level was observed throughout all periods of HFR versus BHD (from 11.1 to 11.86 g/dl; p = 0.04), with a significant decrease of ESA requirements from 29,500 to 25,033 IU/month (p = 0.04). Conclusion: Regardless of the presence or absence of acetate in DS, HFR per se allows a significant lowering of ESA dosage versus BHD, while at the same time increasing Hb levels. Taking for granted the clinical impact produced, HFR seems to provide a relevant decrease in end-stage renal disease patient costs.

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“…As compared with conventional hemodialysis (HD), it is associated with a lower morbidity [4], an improvement of uremic neuropathy, and a lower incidence of carpal tunnel syndrome and joint pain [5][6][7]. To what extent the mode of dialysis influences anemia is yet controversial [1,[8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Long-term effects of high-volume OL HDF on uremia and dialysis-related pathology have not been extensively studied, and there are only a few data concerning anemia [1,3,[8][9][10][11][12][13][14][15][16]. The aim of our study was to quantify the influence of high-volume OL HDF on anemia and the related cost savings of recombinant human erythropoietin (rHuEPO) treatment.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Anemia in Hemodialysis Patients Treated by Hemodiafiltration with High-Volume On-Line-Prepared Substitution Fluid

Bonforte¹,

Grillo²,

Zerbi³

et al. 2002

Blood Purif

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Background: Hemodiafiltration (HDF) is associated with a lower incidence of neuropathy, carpal tunnel syndrome, joint pain, and partial correction of anemia. HDF with on-line-prepared substitution fluid (OL HDF), as compared with conventional hemodialysis, increases the treatment tolerance and, as compared with standard HDF, avoids storage problems and allows a higher substitution volume at low cost. Methods: Thirty-two hemodialysis patients treated by OL HDF for at least 9 months were studied. Hemoglobin, hematocrit, iron metabolism, serum albumin, dialysis dose and dry body weight were determined under a settled condition with regular hemodialysis 3 months before the transfer to OL HDF. The same parameters were analyzed 3, 6 and 9 months after the beginning of the new treatment modality. Results: During OL HDF, hemoglobin values significantly increased in patients without addition of recombinant human erythropoietin (rHuEPO): baseline vs. 6 months 11 ± 1.7 vs. 12 ± 1.8 g/dl (p < 0.01); baseline vs. 9 months 11 ± 1.7 vs. 12 ± 1.6 g/dl (p < 0.05). In patients on a maintenance dose of rhuEPO, this could be significantly reduced, while the target hemoglobin levels were maintained (10.6 ± 0.9 g/dl): baseline 99.8 ± 50.4 U/kg/week, 3rd month 76.2 ± 43 U/kg/week, 6th month 64.3 ± 37 U/kg/week, and 9th month 59.4 ± 38.6 U/kg/week (p = 0.007, p = 0.0006, and p = 0.0007, respectively, vs. baseline). Iron metabolism, dialysis dose, dry body weight and serum albumin levels did not significantly change during the follow-up period. Further, a stability of the rHuEPO supplementation was observed in 14 patients followed up for 24 months. Conclusions: OL HDF influences anemia and rHuEPO dose. It allows considerable anemia correction in patients without rHuEPO treatment, while it significantly reduces rHuEPO doses in those on rHuEPO treatment as compared with standard hemodialysis. The rHuEPO costs are consequently reduced.

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Improvement of Anemia in Patients on Chronic Dialysis Treated by Hemodiafiltration

Cited by 7 publications

References 6 publications

Reviews: Uremic Toxins: A New Focus on an Old Subject

Reviews: Uremic Toxins: A New Focus on an Old Subject

Hemodiafiltration with Endogenous Reinfusion with and without Acetate-Free Dialysis Solutions: Effect on ESA Requirement

Improvement of Anemia in Hemodialysis Patients Treated by Hemodiafiltration with High-Volume On-Line-Prepared Substitution Fluid

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