Optimal Therapeutic Conditions for Online Hemodiafiltration

Canaud, Bernard; Chénine, Leïla; Renaud, Sophie; Leray, Hélène

doi:10.1159/000321742

Cited by 22 publications

(23 citation statements)

References 53 publications

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“…Vascular access is defined as inadequate when it does not permit a blood flow rate of 300 ml/min to be reached [23]. Ideally, patients treated with convective modalities such as OL-HDF require a vascular access capable of delivering consistently a blood flow rate between 350 and 400 ml/min, or higher [24]. In therapies that target the removal of larger solutes, high blood flow rate (in conjunction with appropriate highly permeable membranes, sieving coefficient β 2 M >0.6) facilitates the ultrafiltration rate and reduces the TMP regimen during the treatment session.…”

Section: Practical Clinical Approaches For Optimizing Ultrafiltrationmentioning

confidence: 99%

Achieving High Convective Volumes in On-Line Hemodiafiltration

Bowry

Canaud²

2013

Blood Purif

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On-line hemodiafiltration (OL-HDF) has established itself as a highly efficient and safe form of renal replacement therapy, providing clinical benefits for several conditions that afflict end-stage chronic kidney disease patients. Additionally, evidence now ascribes a survival benefit to OL-HDF. The first indication that mortality rates decline with high-efficiency OL-HDF was provided by the European results from the DOPPS. Since then, the RISCAVID, CONTRAST and the Turkish HDF trials have all substantiated the original findings that higher convection volumes are favorable in terms of improved survival. With the emerging concept of convection volume impacting patient survival, we examine the factors and practical approaches by which maximal convection volumes can actually be achieved and individualized for each patient treated with OL-HDF. We believe that with these factors in mind, all attempts should be made to maximize convective volume, and hence the convective dose, to enable the patient to derive the full benefits of OL-HDF over extended periods.

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Section: Practical Clinical Approaches For Optimizing Ultrafiltrationmentioning

confidence: 99%

Achieving High Convective Volumes in On-Line Hemodiafiltration

Bowry

Canaud²

2013

Blood Purif

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“…Hemodiafiltration (HDF) can efficiently remove uremic toxins, from low-molecular-weight to large-molecular-weight substances, by using a combination of diffusion and convection [1,2,3]. More specifically, the benefits of HDF can be best utilized and good therapeutic efficacy achieved in the treatment of insomnia, pruritus, irritability, restless legs syndrome (RLS), anemia, dialysis amyloidosis (DA), etc., when removal performance of low-molecular-weight protein (LMWP) is improved [4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Biomarkers for Evaluation of Clinical Outcomes of Hemodiafiltration

Sakurai

2013

Blood Purif

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β₂-Microglobulin (β₂-MG) is the substance that causes dialysis amyloidosis, and its predialysis value is useful for evaluating the quality of dialysis therapy itself. In addition, β₂-MG is also an important biomarker for evaluating the removal performance of hemodialysis and hemodiafiltration (HDF). However, since β₂-MG has a molecular weight of 11.8 kDa and can be efficiently removed by diffusion with existing high-performance dialyzers, a higher molecular weight substance should be used for evaluating removal performance of HDF, in which diffusion and convection are performed simultaneously. α₁-Microglobulin (α₁-MG) has a molecular weight of 33 kDa, and it is removed by convection during dialysis. When we used α₁-MG to evaluate the removal performance of HDF in a study based on our own cases, we were able to describe the distinctive features and benefits of HDF with precision. α₁-MG removal rate exactly paralleled the changes in symptoms. Kt/V and the β₂-MG removal rate, however, did not undergo significant changes as the symptoms fluctuated. α₁-MG should be used as a biomarker for evaluation of clinical outcomes of HDF.

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“…The replacement fluid rates that influenced the efficacy of both HDF techniques were equally prescribed at 200 mL/min according to the previous report of the optimal replacement rate in the original mid‐dilution technique (29). Other HDF parameters which were prescribed following the expert recommendation for OL‐HDF requirements including high blood flow rate (300–400 mL/min), high dialysate/replacement flow rate (600 mL/min), and utilization of the highly permeable and adequately sized hemodiafilters (30) which were comparable for both techniques. In spite of the comparable total replacement fluid, the ratios of post : predilution compartment were inferior in the simple mid‐dilution technique.…”

Section: Discussionmentioning

confidence: 99%

Efficacy Comparison Between Simple Mixed‐Dilution and Simple Mid‐Dilution On‐Line Hemodiafiltration Techniques: A Crossover Study

Susantitaphong

Tiranathanagul²,

Katavetin³

et al. 2012

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Mid-dilution and mixed-dilution on-line hemodiafiltration (OL-HDF) techniques are innovated to overcome the limitations of two standard techniques including predilution and postdilution. Unfortunately, the head-to-head comparisons between these two novel techniques in the same study are still limited. Moreover, the original mid-dilution and mixed-dilution OL-HDF need special dialyzers and special machines. In the present study, simple mid-dilution and simple mixed-dilution OL-HDF were settled with the aim for clinical use in general hemodialysis (HD) centers. The efficacies of uremic toxins removal between both modalities were measured and compared. This prospective randomized crossover study was conducted on 12 stable HD patients undergoing simple mixed-dilution and simple mid-dilution OL-HDF techniques. HD prescriptions were similar in both techniques. The dialysis efficacies were determined by calculating small- (urea, creatinine, and phosphate) and middle-molecule (beta-2 microglobulin [β2M]) removal. Moreover, potential complications such as high transmembrane pressure (TMP) and protein loss were also observed. Simple mixed-dilution OL-HDF provided significantly greater clearances of urea, creatinine, and β2M when compared with the simple mid-dilution OL-HDF techniques. Phosphate clearances in both techniques were comparable. In addition, TMP and dialysate albumin loss were not different. There were no intradialytic complications in both techniques. Simple mixed-dilution OL-HDF could provide greater efficacy for small- and middle-molecule clearances and acceptable potential risks, while phosphate removal is comparable.

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Optimal Therapeutic Conditions for Online Hemodiafiltration

Cited by 22 publications

References 53 publications

Achieving High Convective Volumes in On-Line Hemodiafiltration

Achieving High Convective Volumes in On-Line Hemodiafiltration

Biomarkers for Evaluation of Clinical Outcomes of Hemodiafiltration

Efficacy Comparison Between Simple Mixed‐Dilution and Simple Mid‐Dilution On‐Line Hemodiafiltration Techniques: A Crossover Study

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