Long-Term Morbidity: Hemofiltration vs. Hemodialysis

Quellhorst, E; Hildebrand, U.; Solf, Andreas

doi:10.1159/000424220

Cited by 16 publications

(27 citation statements)

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“…This value, represents a weekly stdKt/V of approximately 2.0, which is the recommended value advocated to dose renal replacement therapies that are more frequent than 3 times weekly [21,29] . Indeed, this prescription was considered conservative and safe for DHF as previous studies assessing 3 times weekly HF demonstrated excellent patient outcomes while achieving spKt/V of only 0.6-0.8/session and 60-90 liters of exchange volume per week [12,30] . These data argue for the importance of the convective clearance of middle molecules, for which there are no current clinically accepted adequacy measures.…”

Section: Discussionmentioning

confidence: 99%

“…In the USA, HF has primarily been used in a continuous mode for critically ill patients with acute renal failure [10] . The value of intermittent HF for patients with ESRD has mostly been studied in Europe, offering some potential clinical advantages, including better hemodynamic and cardiovascular stability, enhanced removal of middle molecular weight toxins, increased tolerance, and therapy preference [11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

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Daily Hemofiltration for End-Stage Renal Disease: A Feasibility and Efficacy Trial

Jaber

Zimmerman²,

Teehan³

et al. 2004

Blood Purif

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Background: Although conventional hemodialysis (CHD) is currently provided primarily on an intermittent basis for patients with end-stage renal diseases (ESRD), the value of daily dialysis is well documented. Daily hemofiltration (DHF) is a convective therapy that has received little attention as an alternative to CHD. The aim of this feasibility study was to validate and assess the efficacy of DHF (6 times/week) as an alternative to CHD (3 times/week) in patients with ESRD. Methods: In this prospective single-arm open-labeled study, DHF was administered over 4 weeks after a 1-week run-in phase period of CHD. Blood samples were drawn at baseline and on a weekly basis during the trial, and ultrafiltrate samples were collected weekly during the DHF period. The primary endpoint was to achieve a daily spKt/V of 0.40 (equivalent to a weekly stdKt/V of ∼2.0). To achieve this goal, the DHF prescription consisted of an exchange volume of 40% of total body water. Secondary endpoints were the evaluation of blood pressure and anemia parameters, nutritional and mineral metabolism markers and health-related quality of life measures. Results: Twelve patients completed the study. Mean age was 54 years, two-thirds were men, and 83% had arteriovenous fistulae. DHF delivered a mean (±SD) spKt/V of 0.44 ± 0.06. This goal was reached by delivering an exchange volume of 13–14 liters, consisting of a replacement fluid volume of 11.7 ± 1.9 l/session and net fluid loss of 1.4 ± 0.1 l/session. Conversion from CHD to DHF resulted in marked reduction in treatment time (3.8 vs. 2 h/session, p < 0.001) and net fluid loss (2.6 vs. 1.4 l/session, p < 0.001). Calculated weekly standard Kt/V during the last week of DHF was 1.9 ± 0.2. DHF achieved a median β₂-microglobulin (β₂-M) removal of 170 mg/session, resulting in a decrease of mid-week pre-therapy β₂-M levels (48 ± 34 vs. 36 ± 25 mg/l, p = 0.07). Compared with CHD, DHF resulted in lower systolic (143 ± 19 vs. 133 ± 16 mm Hg, p = 0.002) and diastolic (79 ± 11 vs. 72 ± 12 mm Hg, p = 0.002) blood pressure, reduction in antihypertensive medications (2.1 ± 0.7 vs. 1.1 ± 0.8, p = 0.002), higher caloric intake (1,778 ± 441 vs. 2,044 ± 564 kcal/day, p = 0.01), higher normalized protein catabolic rate (0.88 ± 0.17 vs. 1.00 ± 0.35 g/kg/day, p = 0.05), higher pre-albumin levels (330 ± 50 vs. 378 ± 84 g/dl, p = 0.06), higher vitality (p = 0.02), improved cognitive function (p = 0.04) and less symptoms/problems (p = 0.03). Serum albumin and potassium levels remained unchanged but the serum bicarbonate level dropped during the 1-month period of DHF. Conclusions: DHF (6 times/week) over a 1-month period achieved a weekly stdKt/V of ∼2.0, which is similar to that recommended for 3 times weekly CHD, reduced β₂-M levels, lowered blood pressure, and had some beneficial effect on nutritional parameters, and health-related quality of life measures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Daily Hemofiltration for End-Stage Renal Disease: A Feasibility and Efficacy Trial

Jaber

Zimmerman²,

Teehan³

et al. 2004

Blood Purif

View full text Add to dashboard Cite

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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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“…Quellhorst et al [9] measured the endotoxin concentration in various fl uids and found that the mean concentration in 721 samples of commercially prepared substitution solution was 17.5 Ϯ 6.8 pg/ml, well below the target recommended by the Pharmacopoeia, but still 4 times higher than the average in the 1,364 samples of online prepared fl uid (4.1 Ϯ 0.6 pg/ml). However, the quality of the dialysis fl uid is also important because fl uid fl ux across the dialysis membrane may occur.…”

Section: Quality Of Replacement Fluidmentioning

confidence: 95%

Fluids in Bags for Hemodiafiltration

Ledebo¹

2007

Hemodiafiltration

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The objective of hemodiafiltration (HDF) is to increase the convective transport of solutes poorly removed by diffusion, and therefore ultrafiltration (UF) beyond the desired weight loss is prescribed. The excess UF is compensated for by infusion of a physiological solution which should be sterile and nonpyrogenic. This replacement solution can be provided either in bags containing commercially prepared infusion solution, i.e. so-called classic HDF, or by an integrated stepwise filtration of the dialysis fluid, i.e. so-called online HDF. In both cases the composition of the replacement solution should mirror that of plasma water. When the fluid is provided in bags, practical handling is a limiting factor, and the amount of convection that can be delivered is most often restricted to 10-12 l/session. Results from clinical studies show that the degree of convective transport obtained in classic HDF corresponds to what can be achieved in contemporary high-flux dialysis, where uncontrolled UF and backfiltration take place inside the dialyzer. Classic HDF with replacement fluid in bags offers the possibility of delivering an HDF treatment with controlled convective dose and fluid quality, albeit with a limited amount of convection.

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Long-Term Morbidity: Hemofiltration vs. Hemodialysis

Cited by 16 publications

References 0 publications

Daily Hemofiltration for End-Stage Renal Disease: A Feasibility and Efficacy Trial

Daily Hemofiltration for End-Stage Renal Disease: A Feasibility and Efficacy Trial

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

Fluids in Bags for Hemodiafiltration

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