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

Altieri, Paolo; Sorba, Gianbattista; Bolasco, Piergiorgio; Boström, M.; Asproni, Emilio; Ferrara, Rocco; Bolasco, F; Cossu, Maria Vittoria; Cadinu, Franco; Cabiddu, Gianfranca; Casu, Domenica; Ganadu, Marino; Passaghe, Mario; Pinna, Mario

doi:10.1159/000170328

Cited by 40 publications

(17 citation statements)

References 10 publications

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“…This is consistent with the report of Kerr et al [11]. However, this phenomenon is in contrast to the previous observation that the use of on-line hemofiltration and high-flux membranes could achieve a comparable nPCR with a lower KT/V delivered [18,19]. As suggested Pre-ß 2 -M level = Predialysis ß 2 -microglobulin level (mg/l); pre-ß 2 -M level before HDF = predialysis ß 2 -microglobulin level before switching to on-line HDF; pre-ß 2 -M level after HDF = predialysis ß 2 -microglobulin level after switching to on-line HDF; post-ß 2 -M level = postdialysis ß 2 -microglobulin level after switching to HDF.…”

Section: Discussionsupporting

confidence: 91%

Long-Term On-Line Hemodiafiltration Reduces Predialysis Beta-2-Microglobulin Levels in Chronic Hemodialysis Patients

et al. 2001

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Background: Hemodiafiltration (HDF) is effective in delaying the surgical need for carpal tunnel syndrome in chronic hemodialysis patients, however, predialysis β₂-microglobulin levels were not reduced in most short-term studies. The aim of this study was to assess the effect of long-term and differing frequencies of on-line HDF on serum β₂-microglobulin levels in comparison to high-flux hemodialysis (HD). Methods: One hundred and twelve patients in the Chang Gung Memorial Hospital Dialysis Unit were divided into three groups to receive different frequencies of on-line HDF alternating with high-flux HD. Group 1 was treated once with HDF and twice with high-flux HD per week (n = 21). Group 2 was treated twice with HDF and once with high-flux HD per week (n = 33). Group 3 was treated with HDF three times per week (n = 58). Analysis was performed to compare the serum β₂-microglobulin levels in these groups and to high-flux HD. Results: After receiving HDF for a mean of 7.9 months, group 3 patients had a reduced predialysis β₂-microglobulin level (22.2 ±5.3 vs. 34.8 ±6.3 mg/l, p < 0.001), postdialysis β₂-microglobulin level (6.3 ± 2.0 vs. 13.8 ± 6.8 mg/l, p < 0.001) and an increased β₂-microglobulin reduction rate (76.1 ± 5.6 vs. 61.1 ± 13.3%, p = 0.03) when compared to high-flux HD. A significant improvement in URR (p = 0.0004), Kt/V (p = 0.0002) and TAC urea levels (p = 0.006) but not nPCR (p = 0.122) was found after patients had been treated with on-line HDF. The β₂-microglobulin reduction rate was positively correlated with the overall volume of the replacement solution per session (p < 0.0001). Patients in group 3 had lower predialysis β₂-microglobulin levels than those in group 1 and group 2 (22.2 ± 5.3 vs. 25.2 ± 7.2 vs. 26.0 ± 4.2 mg/l, p = 0.02). Furthermore, an inverse correlation was found between the predialysis β₂-microglobulin level and the duration of HDF, if patients were treated for more than 12 months (p = 0.031). Conclusion: On-line HDF has an increased dialysis efficiency compared to high-flux dialysis. Long-term HDF further reduced predialysis β₂-microglobulin levels, thus, it may provide an improved modality for renal replacement therapy.

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Section: Discussionsupporting

confidence: 91%

Long-Term On-Line Hemodiafiltration Reduces Predialysis Beta-2-Microglobulin Levels in Chronic Hemodialysis Patients

et al. 2001

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“…Moreover, it has been shown that the rate of small solute removal is less rapid during HDF than during HD, and this can influence the hemodynamic stability [25]. In addition, the potential advantages of HDF are the convective removal of medium molecules and the biocompatibility of membranes, which significantly contributes to reduction in the inflammatory processes that are implicated in dialysis morbidity and mortality [26].…”

Section: Discussionmentioning

confidence: 99%

β<sub>2</sub>-Microglobulin, Pulse Pressure and Metabolic Alterations in Hemodialysis Patients

Raikou

Tentolouris²,

Kyriaki³

et al. 2010

Nephron Clin Pract

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Background/Aim: Pulse pressure (PP) is a result of arterial stiffness seen in dialysis patients, but may be a consequence of fluid overload. We examined the role of β₂-microglobulin (β₂M) in PP in relation to metabolic alterations in patients on different hemodialysis (HD) modalities. Methods: We studied 76 hemodialyzed patients on regular HD (n = 34), predilution bagged hemodiafiltration (n = 19) and online predilution hemodiafiltration (n = 23). β₂M levels were measured by radioimmunoassay, and the clearance of β₂M was assessed by Kt/V for β₂M. Arterial stiffness was measured as carotid-femoral pulse wave velocity, and PP was derived. Insulin levels were measured using immunoradioassay, and insulin resistance was calculated using homeostasis model assessment insulin resistance (HOMA-IR). Serum bicarbonate levels were measured using a blood gas analyzer, and percent sodium removal was calculated. Results: β₂M levels predict increased PP (p = 0.02) adjusting for age, HD modalities, HD duration, HOMA-IR and percent sodium removal. β₂M was positively associated with HOMA-IR (r = 0.306, p = 0.007). Serum bicarbonate levels and carotid-femoral pulse wave velocity were inversely associated (r = –0.719, p = 0.001). Conclusions: β₂M levels were positively associated with PP, which was influenced mainly by dialysis modality fluid and sodium balance and less by arterial stiffness. β₂M levels were positively associated with insulin resistance. Uremic acidosis may contribute to arterial stiffness.

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“…Hemodiafiltration (HDF) provides solute removal over a wide molecular weight range [1] and is considered a suitable dialysis technique for patients with a poor cardiovascular stability [2,3]. 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].…”

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

Cited by 40 publications

References 10 publications

Long-Term On-Line Hemodiafiltration Reduces Predialysis Beta-2-Microglobulin Levels in Chronic Hemodialysis Patients

Long-Term On-Line Hemodiafiltration Reduces Predialysis Beta-2-Microglobulin Levels in Chronic Hemodialysis Patients

β<sub>2</sub>-Microglobulin, Pulse Pressure and Metabolic Alterations in Hemodialysis Patients

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

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