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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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      Elevated Removal of Middle Molecules without Significant Albumin Loss with Mixed-Dilution Hemodiafiltration for Patients Unable to Provide Sufficient Blood Flow Rates

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          Abstract

          Background: We examined the hypothesis that mixed-dilution online hemodiafiltration (MIXED) rather than predilution online hemodiafiltration (PRE) could enable patients with low blood flow rate (Q<sub>b</sub>) to benefit from advantages of convective therapies. Methods: Thirty-eight patients were included in a prospective, randomized, crossover and multicenter study conducted with a view to comparing the equilibrated Kt/V, reduction ratio (RR) of phosphates, β<sub>2</sub>-microglobulin (β<sub>2</sub>-M) and myoglobin (myo) between PRE and MIXED, each at two Q<sub>b</sub> values of 250 and 300 ml/min during 4 h sessions with a FX1000HDF dialyzer. Albumin losses (Alb) were also measured in 12 patients. Results: MIXED was always found to be more efficient compared to PRE notably for middle molecules (MM). RRβ<sub>2</sub>-M: MIX250: 81.3 ± 3.6 vs. PRE250: 75.2 ± 5.9; MIX300: 82.7 ± 3.6 vs. PRE300: 78.1 ± 5.4; RRmyo: MIX250: 70.2 ± 3.6 vs. PRE250: 42.6 ± 2.6; MIX300: 70.6 ± 3.6 vs. PRE300: 45.7 ± 3.6 and with Alb <3.0 g/session. Conclusion: MIXED allows patients unable to provide sufficiently high Q<sub>b</sub> to achieve high levels of MM removal.

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          Factors influencing serum albumin in dialysis patients.

          G Kaysen, J Yeun (1998)
          Hypoalbuminemia is a major risk factor for morbidity and mortality in dialysis patients. The proximate cause of hypoalbuminemia is probably responsible for these events, and not the hypoalbuminemia itself. Because protein-calorie malnutrition decreases albumin synthesis, hypoalbuminemia has been attributed to poor nutritional intake resulting from underdialysis. However, serum albumin (Salb) level is determined by several other factors: plasma volume expansion, albumin redistribution, exogenous loss, increased fractional catabolic rate (FCR), and decreased synthesis. Decreased albumin synthesis is primarily responsible for hypoalbuminemia in hemodialysis (HD) patients. Studies of a smaller number of peritoneal dialysis (PD) patients suggest exogenous albumin loss and volume expansion as contributing mechanisms. However, both malnutrition and inflammation suppress albumin synthesis. As the adequacy of dialysis has improved, recent studies are unable to show any relation between dialysis adequacy and Salb level. Further, Salb level appears to be a poor marker of nutritional status in dialysis patients when compared with other measures of nutrition, such as subjective global assessment score, anthropometry, and dietary intake. Instead, cytokines and positive acute-phase reactants, produced in response to inflammation, have been identified as important contributors to hypoalbuminemia in dialysis patients. These markers correlate with hypoalbuminemia and supercede Salb level in predicting mortality. Multivariate analysis identifies markers of inflammation and nutritional status as independent predictors of hypoalbuminemia in HD patients and markers of inflammation and peritoneal albumin loss as independent predictors in PD patients. However, the acute-phase response and malnutrition are closely interrelated, because inflammatory mediators also suppress appetite, increase muscle catabolism, and result in progressive cachexia. Future studies should focus on elucidating the inflammatory stimuli and the complex interaction between the acute-phase response and nutritional status.
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            NO CHANGE IN CORRECTED β2-MICROGLOBULIN CONCENTRATION AFTER CUPROPHANE HAEMODIALYSIS

            J. Bergström, B Wehle (1987)
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              High permeability of dialysis membranes: what is the limit of albumin loss?

              Detlef Krieter, Bernard Canaud (2003)
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): BPU
                Journal ID (nlm-ta): Blood Purif
                Journal ID (doi): 10.1159/issn.0253-5068
                Title: Blood Purification
                Publisher: S. Karger AG
                ISSN (Print): 0253-5068
                ISSN (Electronic): 1421-9735
                Publication date Subscription-year: 2013
                Publication date (Print): November 2013
                Publication date (Electronic): 29 August 2013
                Volume: 36
                Issue: 2
                Pages: 78-83
                Affiliations
                aDialysis Unit, Centre Hospitalier, Cherbourg, bDialysis Unit, Centre Hospitalier Universitaire, Rouen, cDialysis Unit, Centre Hospitalier, Elbeuf, dDialysis Unit, Centre Hospitalier, Alençon, eDialysis Unit, Centre Hospitalier, Saint-Malo, fDialysis Unit, ECHO, Cholet, gDialysis Unit, Centre Hospitalier, Quimper, hDialysis Unit, Centre Hospitalier, Laval, iDialysis Unit, Centre Hospitalier, Cholet, and jDialysis Unit, ECHO, Angers, France
                Author notes
                *Jacky Potier, Service d'hémodialyse et de néphrologie, Centre Hospitalier Public du Cotentin, 42, rue du Val de Saire, FR-50102 Cherbourg (France), E-Mail Jacky.potier2@wanadoo.fr
                Article
                Publisher ID: 351527 Other ID: Blood Purif 2013;36:78-83
                DOI: 10.1159/000351527
                PubMed ID: 23989087
                SO-VID: 500484de-b1b5-4df5-a5fd-e5bff3f1feb5
                Copyright © © 2013 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 06 November 2012
                Date accepted : 17 April 2013
                Page count
                Figures: 5, Tables: 1, Pages: 6
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Albumin loss,Blood flow rates,Middle molecule removal ,Mixed-dilution online hemodiafiltration,Online hemodiafiltration,Predilution online hemodiafiltration
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Albumin loss, Blood flow rates, Middle molecule removal , Mixed-dilution online hemodiafiltration, Online hemodiafiltration, Predilution online hemodiafiltration

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