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      Haemodiafiltration: Current Status


      Nephron Clinical Practice

      S. Karger AG

      Convective therapy, Haemodialysis, Haemodiafiltration

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          Haemodiafiltration combines elements of diffusion and convection in a single treatment modality to provide solute removal over a wide range of molecular weights. Theoretically, it represents the best available form of renal replacement therapy but uptake of the technique has been slow. This pattern may change, given the growing acceptance of the potential benefits of the technique, the maturing technology including cost-efficient online production of substitution fluid, and the demonstration of the long-term safety of the technique. Long-term clinical outcome data are awaited.

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          Identical decline of residual renal function in high-flux biocompatible hemodialysis and CAPD.

          Patients on conventional hemodialysis lose residual renal function more rapidly than patients on continuous ambulatory peritoneal dialysis (CAPD). The effect of dialysis using synthetic membranes and ultrapure water is less clear. The decline of urea clearance was compared in a cohort of 475 incident end-stage renal failure patients who received treatment with CAPD (N=175) or hemodialysis (HD) utilizing high-flux polysulphone membranes, ultrapure water, and bicarbonate as the buffer (N=300). CAPD patients were significantly younger, fitter (lower comorbidity severity score), less dependent (higher Karnofsky performance score) and less likely to have presented late than HD patients. There was no difference in the mean urea clearance in each group at dialysis initiation, or at any 6-month time point during the ensuing 48 months. This was true even after exclusion of patients who had died in the first year after initiation, those transferred to another dialysis modality, or those who had been transplanted. Only age and chronic interstitial disease predicted retention of urea clearance at one year. The rate of decline of urea clearance was similar in pre- and post-dialysis initiation phases, though there may have been a step-decline of about 2 mL/min at initiation, which requires further investigation. In hemodialysis using high-flux biocompatible membranes and ultrapure water, residual renal function declines at a rate indistinguishable from that in CAPD. This may have important implications, since preservation of residual renal function has major benefits and is a valid therapeutic goal.
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            Improvement of Anemia in Hemodialysis Patients Treated by Hemodiafiltration with High-Volume On-Line-Prepared Substitution Fluid

            Background: Hemodiafiltration (HDF) is associated with a lower incidence of neuropathy, carpal tunnel syndrome, joint pain, and partial correction of anemia. HDF with on-line-prepared substitution fluid (OL HDF), as compared with conventional hemodialysis, increases the treatment tolerance and, as compared with standard HDF, avoids storage problems and allows a higher substitution volume at low cost. Methods: Thirty-two hemodialysis patients treated by OL HDF for at least 9 months were studied. Hemoglobin, hematocrit, iron metabolism, serum albumin, dialysis dose and dry body weight were determined under a settled condition with regular hemodialysis 3 months before the transfer to OL HDF. The same parameters were analyzed 3, 6 and 9 months after the beginning of the new treatment modality. Results: During OL HDF, hemoglobin values significantly increased in patients without addition of recombinant human erythropoietin (rHuEPO): baseline vs. 6 months 11 ± 1.7 vs. 12 ± 1.8 g/dl (p < 0.01); baseline vs. 9 months 11 ± 1.7 vs. 12 ± 1.6 g/dl (p < 0.05). In patients on a maintenance dose of rhuEPO, this could be significantly reduced, while the target hemoglobin levels were maintained (10.6 ± 0.9 g/dl): baseline 99.8 ± 50.4 U/kg/week, 3rd month 76.2 ± 43 U/kg/week, 6th month 64.3 ± 37 U/kg/week, and 9th month 59.4 ± 38.6 U/kg/week (p = 0.007, p = 0.0006, and p = 0.0007, respectively, vs. baseline). Iron metabolism, dialysis dose, dry body weight and serum albumin levels did not significantly change during the follow-up period. Further, a stability of the rHuEPO supplementation was observed in 14 patients followed up for 24 months. Conclusions: OL HDF influences anemia and rHuEPO dose. It allows considerable anemia correction in patients without rHuEPO treatment, while it significantly reduces rHuEPO doses in those on rHuEPO treatment as compared with standard hemodialysis. The rHuEPO costs are consequently reduced.

              Author and article information

              Nephron Clin Pract
              Nephron Clinical Practice
              S. Karger AG
              March 2003
              17 November 2004
              : 93
              : 3
              : c87-c96
              Renal Unit, Lister Hospital, Stevenage, UK
              69545 Nephron Clin Pract 2003;93:c87–c96
              © 2003 S. Karger AG, Basel

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              Page count
              Figures: 8, Tables: 2, References: 30, Pages: 1
              Self URI (application/pdf):
              Minireview: Therapeutic Advances

              Cardiovascular Medicine, Nephrology

              Convective therapy, Haemodiafiltration, Haemodialysis


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