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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

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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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      Evaluation of a New Online Hemodiafiltration Mode with Automated Pressure Control of Convection

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          Abstract

          Background: Postdilution hemodiafiltration (HDF) still remains the gold standard for solute removal, but with high hemoglobin levels transmembrane pressure (TMP) may reach high levels, reducing filter performance. We compared three online postdilution HDF treatments without TMP alarms for convective volume and plasma changes following treatment. Methods: Twelve patients were enrolled in a trial with three online postdilution HDF treatments. In the volume-controlled mode (VOLc), we set the exchanged volume to obtain a filtration fraction close to 25% without TMP alarms. In the pressure-controlled mode (TMPc), we set the TMP at 100 mm Hg. In the ULTRAc mode (TMP scan combined with TMPc), the dialysis machine automatically selects the TMP with a scan. All treatments were performed with an AK200 ULTRA-S system. Results: Even with hemoglobin levels >12 g/dl, we found a 57% rise in ultrafiltration rate in TMPc versus VOLc and a 92% rise in ULTRAc versus VOLc. Phosphates and myoglobin levels were significantly affected by treatment type. Conclusions: ULTRAc may be a useful tool to achieve an excellent purification performance without the constraints associated with the risk of hemoconcentration.

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          Phosphate kinetics during hemodialysis: Evidence for biphasic regulation.

          Ken Farrington, Paul W Chamney, Peter Spalding (2002)
          Hyperphosphatemia in the hemodialysis population is ubiquitous, but phosphate kinetics during hemodialysis is poorly understood. Twenty-nine hemodialysis patients each received one long and one short dialysis, equivalent in terms of urea clearance. Phosphate concentrations were measured during each treatment and for one hour thereafter. A new model of phosphate kinetics was developed and implemented in VisSim. This model characterized additional processes involved in phosphate kinetics explaining the departure of the measured data from a standard two-pool model. Pre-dialysis phosphate concentrations were similar in long and short dialysis groups. Post-dialysis phosphate concentrations in long dialysis were higher than in short dialysis (P < 0.02) despite removal of a greater mass of phosphate (P < 0.001). In both long and short dialysis serum phosphate concentrations initially fell in accordance with two-pool kinetics, but thereafter plateaued or increased despite continuing phosphate removal. Implementation of an additional regulatory mechanism such that a third pool liberates phosphate to maintain an intrinsic target concentration (1.18 +/- 0.06 mmol/L; 95% confidence intervals, CI) explained the data in 24% of treatments. The further addition of a fourth pool hysteresis element triggered by critically low phosphate levels (0.80 +/- 0.07 mmol/L, CI) yielded an excellent correlation with the observed data in the remaining 76% of treatments (cumulative standard deviation 0.027 +/- 0.004 mmol/L, CI). The critically low concentration correlated with pre-dialysis phosphate levels (r=0.67, P < 0.0001). Modeling of phosphate kinetics during hemodialysis implies regulation involving up to four phosphate pools. The accuracy of this model suggests that the proposed mechanisms have physiological validity.
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            Hemodiafiltration: clinical evidence and remaining questions.

            Peter J. Blankestijn, Ingrid Ledebo, Bernard Canaud (2010)
            Currently, about two-thirds of hemodialysis patients worldwide are treated with high-flux membranes. This is most likely based on the assumption that the extended solute clearance that can be obtained with more open membranes will contribute to improved clinical outcome. To have full advantage of convective solute removal, hemodiafiltration offers a superior modality as compared to both low-flux and high-flux hemodialysis. However, this technique is offered to only a minority of patients. In this review, we summarize the available clinical evidence on hemodiafiltration and define still remaining questions.
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              The best dialysis therapy? Results from an international survey among nephrology professionals

              Ingrid Ledebo, Claudio Ronco (2008)
              Background. There is little evidence for superior outcome of one dialysis therapy versus another. Still, nephrologists have to prescribe dialysis every day. It is therefore of interest to ascertain the opinion among nephrology professionals regarding which therapy they consider to be the best and to compare this to reality. Methods. We designed a survey addressing these questions and distributed it at five international dialysis and nephrology congresses during 2007. Results. Responses were collected from 6595 delegates, 57% physicians and 28% nurses. Peritoneal dialysis (PD) was considered the best initial dialysis therapy for a planned start in a typical patient. The dialysis treatment chosen to be best for long-term use was home/self-care dialysis applied >3 times/week. The best extracorporeal form of dialysis among European respondents was high-volume haemodiafiltration (HDF), while the Asians and Americans gave preference to high-flux haemodialysis (HD). Only 7% preferred low-flux HD. Finally, the respondents were asked what level of evidence they would require to consider one form of dialysis superior to another. The majority wanted hard evidence, i.e. improved survival, to make such a distinction. Conclusions. The view of nephrology professionals on the value of different dialysis therapies reflects current scientific discussions. They consider PD to be the best initial therapy and frequent application of home/self-care dialysis to be the best long-term therapy. High-flux membranes are strongly preferred for any extracorporeal form of therapy, and HDF seems to be the modality of choice among Europeans. The opinions expressed are far from reality, which we interpret to show that non-medical factors have a strong impact on treatment allocation.
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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: 2011
                Publication date (Print): June 2011
                Publication date (Electronic): 14 January 2011
                Volume: 31
                Issue: 4
                Pages: 259-267
                Affiliations
                aNephrology and Dialysis Unit, Ospedale ‘Caduti Bollatesi’, Bollate, and bHospal S.p.A., Bologna, Italy
                Author notes
                *Ugo Teatini, MD, Nephrology and Dialysis Unit, Ospedale ‘Caduti Bollatesi’, Via Piave 20, IT–20021 Bollate (Italy), Tel. +39 029 9430 5200, Fax +39 029 9430 5306, E-Mail nefrologiab@aogarbagnate.lombardia.it
                Article
                Publisher ID: 321884 Other ID: Blood Purif 2011;31:259–267
                DOI: 10.1159/000321884
                PubMed ID: 21242679
                SO-VID: 91bacc2c-8a6b-4bb5-beeb-de50308fc94c
                Copyright © © 2011 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 : 27 April 2010
                Date accepted : 05 October 2010
                Page count
                Figures: 6, Tables: 3, Pages: 9
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Transmembrane pressure,Postdilution hemodiafiltration,Convective volume
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Transmembrane pressure, Postdilution hemodiafiltration, Convective volume

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