| New strategies in haemodiafiltration (HDF): prospective comparative analysis between on-line mixed HDF and mid-dilution HDF. | |
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MedLine Citation:
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PMID: 17347283 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Improvement in the uraemic toxicity profile obtained with the application of convective and mixed dialysis techniques has stimulated the development of more efficient strategies. Our study was a prospective randomized evaluation of the clinical and technical characteristics of two new haemodiafiltration (HDF) strategies, mixed HDF and mid-dilution HDF, which have recently been proposed with the aim of increasing efficiency and safety with respect to the standard traditional HDF infusion modes. METHODS: Ten stable patients on renal replacement therapy (mean age 64.7 +/- 8.2 years) were submitted in randomized sequence to one mid-week session of mid-dilution HDF and one of mixed HDF with trans-membrane pressure feedback control. All sessions were carried out under similar operating conditions and involved monitoring pressure within the internal dialyser compartments and calculating the rheological and hydraulic indexes. Efficiency in removing urea, phosphate and beta2-microglobulin (beta2-m) was tested. RESULTS: In mixed HDF, safer and more effective flux/pressure conditions resulted in better preservation of the hydraulic and solute membrane permeability (mean in vivo ultrafiltration coefficient 36.9 +/- 3.9 vs 20.1 +/- 3.3 ml/h/mmHg) and ensured higher volume exchange (38.7 +/- 4.2 vs 35.3 +/- 6.5 l/session, P = 0.02) and greater efficiency in removing small and middle molecules (mean urea clearance: 274 +/- 42 vs 264 +/- 47 ml/min, P = 0.028; eKt/V: 1.78 +/- 0.22 vs 1.71 +/- 0.26, P = 0.036; mean phosphate clearance: 138 +/- 16 vs 116 +/- 45 ml/min, P = 0.2; mean beta2-m clearance: 81 +/- 13 vs 59 +/- 13 ml/min, P = 0.001). CONCLUSIONS: Mixed HDF was the most efficient technique in the highest range of safe operating conditions. In mid-dilution HDF, high pressures generated inside the dialyser compromised membrane permeability and limited the total infusion rate, resulting in an overall reduction in solute removal. |
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Authors:
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Annalisa Feliciani; Maria Alessandra Riva; Simona Zerbi; Pio Ruggiero; Anna Rita Plati; Giorgio Cozzi; Luciano A Pedrini |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2007-03-08 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 22 ISSN: 0931-0509 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2007 Jun |
Date Detail:
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Created Date: 2007-05-28 Completed Date: 2007-08-17 Revised Date: 2008-05-01 |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 1672-9 Citation Subset: IM |
Affiliation:
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Department of Nephrology and Dialysis, Ospedale Bolognini, 24068-SERIATE, Bergamo, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Hemodiafiltration / methods*, trends Humans Male Middle Aged Monitoring, Physiologic / methods Pressure Prospective Studies |
| Comments/Corrections | |
Comment In:
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Nephrol Dial Transplant. 2008 Apr;23(4):1465-6; author reply 1466
[PMID:
17881427
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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