Superiority of Hemofiltration to Hernodialysis for Treatment of Chronic Renal Failure: Comparative Studies Between Hernofiltration and Hernodialysis on Dialysis Disequilibrium Syndrome

Abstract

A significantly lower incidence of DDS, hypotension, and impending shock was found during and after hemofiltration as compared with conventional hemodialysis. Hemofiltration, in contrast to hemodialysis, showed less decrease of circulating plasma volume, mild change in plasma osmolality without red cell swelling, better compensation of acidosis despite less uptake of acetate, more stable PCO2 during the procedure, less paradoxical acidosis in cerebrospinal fluid, and a lower urea concentration gradient between cerebrospinal fluid and plasma. These phenomena might be explained by better mass transfer between compartments bithin the body during hemofiltration. Mass transfer from the intracellular as well as the extracellular space to circulating plasma occurred more rapidly and smoothly during HF than during HD. HF is preferable to HD in patients with severe cardiovascular complications such as hypertension, as well as hypotension and cardiac failure, and in those subject to DDS during HD. Accordingly, hemofiltration therapy promises patients more comfortable and more stable treatment of chronic uremia.

Haemodiafiltration Results in Similar Changes in Intracellular Water and Extracellular Water Compared to Cooled Haemodialysis

“…Others reported that haemofiltration treatments were associated with a smaller decrease in circulating plasma volume, with less change in plasma osmolality without red cell swelling, and invasive sampling of cerebrospinal fluid was reported to show less paradoxical acidosis in cerebrospinal fluid, with a lower urea concentration gradient between cerebrospinal fluid and plasma [8]. It was therefore suggested that these changes resulted from improved mass transfer between compartments within the body during treatment with haemofiltration compared to HD.…”

“…The reduction in intra-session hypotension with convective techniques has at times been variously attributed to improved sympathetic nervous system activity [5], greater thermal losses [6], and relatively greater sodium retention [7]. As such haemofiltration has been reported to achieve faster mass transfer between compartments within the body with more rapid mass transfer both from the intracellular as well as from the extracellular space into the plasma [8]. Bioimpedance has been used to assess changes in extracellular water (ECW) and intracellular water (ICW) during dialysis sessions [9].…”

Comparative Studies between Hemofiltration and Hemodialysis on Urea and Isotope-Labelled Sodium Kinetics

“…Since blood was purified at first in both methods, the circulating blood com partment was affected most. It is well known that the circulating blood volume decreases during both methods [3,5]. The change in serum protein concentration was measured in a separate experiment to estimate the change in circulating blood volume [5], A solid decrease in circulating blood volume was found in both methods, but the change was greater in HD.…”

“…It is well known that the circulating blood volume decreases during both methods [3,5]. The change in serum protein concentration was measured in a separate experiment to estimate the change in circulating blood volume [5], A solid decrease in circulating blood volume was found in both methods, but the change was greater in HD. It is assumed that a larger decrease in blood volume with a higher clear ance rate may give considerable influence on the disappearance rate in HD.…”

“…Accordingly, easy and asymptomatic removal of excess body fluid is possible by HF, leading to better control of hypertensive as well as hypotensive patients. Quellhorst et al [1] and ourselves [5] have postulated that one-way mobilization of body fluid from the intracellular to the extra cellular compartment might occur during HF owing to a smaller decrease in plasma osmo lality. In order to clarify this hypothesis, the kinetics of urea and sodium, which contrib ute greatly to extracellular fluid osmolality, were studied during HD and HF.…”