Push/Pull Hemodiafiltration: Technical Aspects and Clinical Effectiveness

Maeda, Kenji; Shinzato, Toru

doi:10.1159/000188666

Cited by 15 publications

(18 citation statements)

References 11 publications

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“…Dual-stage HDF using dialyzers in series also enhances the total amount of ultrafiltration, but no replacement fluid infusion is required because continuous filtration at the upstream dialyzer, which exceeds the desired weight loss, is compensated for by backfiltration at the downstream dialyzer [7][8][9] . A similar but simpler method, the so-called push/pull HDF method which relies on repeated cycles of ultrafiltration and backfiltration [10][11][12][13][14][15] , was introduced to increase convective mass transfer, but this system requires an additional device, i.e. a double compartment piston pump, to regulate instantaneous blood and dialysate pressures [16] .…”

Section: Discussionmentioning

confidence: 99%

Pulse Push/Pull Hemodialysis in a Canine Renal Failure Model

Lee¹,

Min²,

Mun

et al. 2008

Blood Purif

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A new dialysis modality was devised to increase convective mass transfer. Blood and dialysate are circulated by a pulsatile pump, but with pulsatile flow patterns that are 180° out of phase, which causes blood-to-dialysate pressure gradients to oscillate between positive and negative. In the present study, hemodialytic performance of the devised modality was investigated using a canine renal failure model. Membrane hydraulic permeabilities (K_uf) and fiber bundle volumes (FBV) were measured after each dialysis session. Postdialysis K_uf and FBV were then compared with those with conventional high-flux hemodialysis. No complications concerning animals or technical problems with the devised modality were encountered. Urea and creatinine reductions were satisfactory. Postdialysis K_uf and FBV values were significantly reduced after hemodialysis sessions, but were higher for the new modality. The devised modality incorporated with blood and dialysate pulsation offers a simple but safe means new mode of hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Pulse Push/Pull Hemodialysis in a Canine Renal Failure Model

Lee¹,

Min²,

Mun

et al. 2008

Blood Purif

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“…The patients were treated with 4-hour hemodialysis using a pyrogen-free bicarbonate dialysate prepared according to a method reported elsewhere [38, 39]. During the study period, the predialysis endotoxin level in dialysate was confirmed to be undetectable by means of a Limulus amebocyte lysate assay (Endotoxin Wako; Wako Pure Chemical Industries, Osaka, Japan) [40].…”

Section: Methodsmentioning

confidence: 99%

“…This study was conducted in a prospective crossover fashion to reduce the individual variability, and the patients were treated using a pyrogen-free bicarbonate dialysate prepared according to a method reported elsewhere [38, 39]. During the study period, the endotoxin level in dialysate was confirmed to be undetectable by means of Limulus amebocyte lysate assay [40].…”

Section: Introductionmentioning

confidence: 99%

Platelet GPIIb/IIIa Is Activated and Platelet-Leukocyte Coaggregates Formed in vivo during Hemodialysis

Kono

Nakai

Misawa

et al. 2002

Nephron

Self Cite

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Background/Aim: During hemodialysis, platelets and leukocytes are activated and form platelet-leukocyte coaggregates in which GPIIb/IIIa (CD41/CD61) and CD62P (P-selectin) are involved. However, it is still controversial whether platelet activation and platelet-leukocyte coaggregate formation are dependent on the dialyzer membrane material. Method: We examined the appearance of activation-dependent antibody on platelets as an index of platelet activation, and the appearance of platelet-specific antigen on leukocytes as an index of platelet-leukocyte coaggregation, during hemodialysis in 7 patients treated using regenerated cellulose (RC) membrane and next using polysulfone (PS) membrane. In order to reduce the influence of factors other than dialyzer membrane material, this study was conducted in a prospective crossover fashion using a pyrogen-free bicarbonate dialysate. Moreover, flow cytometric techniques with whole blood were employed, which reduce artificial cell activation during the cell or plasma separation procedure. The platelet-specific monoclonal antibodies used in this study were anti-CD61, PAC-1 (which recognizes only the conformationally activated GPIIb/IIIa) and anti-CD62P. Results: Changes in the percentage of PAC-1-positive platelets were significantly greater during hemodialysis with RC than with PS. However, changes in the percentage of CD62P-positive platelets were not significantly different between hemodialysis with RC and PS. Changes in the percentage of CD61- or CD62P-positive leukocytes were significantly greater during hemodialysis with RC than with PS. Although changes in percentage of PAC-1-positive platelets did not parallel those of CD62P-positive platelets during hemodialysis, there was a significant positive correlation between the percentage of CD61-positive leukocytes and the percentage of CD62P-positive leukocytes. Conclusion: This study, conducted in a prospective crossover fashion using a pyrogen-free bicarbonate dialysate in order to reduce the influence of factors other than the dialyzer membrane material, demonstrated that both the degrees of GPIIb/IIIa activation and platelet-leukocyte coaggregation were greater during hemodialysis with RC than PS.

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“…68 The PP HDF unit tends to relieve symptoms such as arthralgia (joint pain), irritability, pruritus, and insomnia more rapidly than conventional HD mode. [69][70][71] Furthermore, the optimal maintenance of membrane permeabilities by prompt BF has the added benefit of considerably inhibiting albumin loss in addition to increasing convection and diffusion. 72 During PP HDF, backward flushing of dialysate takes place within the time frame required for the protein layer to fully develop, and thus, it can effectively wash out the inner lumen and inhibit excessive albumin leakage.…”

Section: Push/pull Techniquesmentioning

confidence: 99%

Substitution-Free Hemodiafiltration

Lee

Pino

Humes³

2012

ASAIO Journal

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Hemodiafiltration (HDF) has been reported to deliver better dialysis outcomes in patients with end-stage renal disease. Technical advances now allow online-based HDF to be used on a clinical basis. However, HDF is being performed at a limited rate because of the requirement of exogenous fluid infusion, which causes safety and cost issues. Therefore, various modifications on HDF strategies have been devised to achieve the HDF without exogenous fluid infusion, which can be achieved by spontaneous fluid reinfusion. In this article, substitution-free HDF strategies are reviewed in detail, with specific attention to technical aspects of the methodology, in vivo and in vitro efficacies, and applicability to clinical use.

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Push/Pull Hemodiafiltration: Technical Aspects and Clinical Effectiveness

Cited by 15 publications

References 11 publications

Pulse Push/Pull Hemodialysis in a Canine Renal Failure Model

Pulse Push/Pull Hemodialysis in a Canine Renal Failure Model

Platelet GPIIb/IIIa Is Activated and Platelet-Leukocyte Coaggregates Formed in vivo during Hemodialysis

Substitution-Free Hemodiafiltration

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