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      Selection of Dilutional Method for On-Line HDF, Pre- or Post-Dilution

      Blood Purification

      S. Karger AG

      One-line hemodiafiltration, Pre-dilution, Post-dilution, LMWPs, Safety control

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          Abstract

          Post- and pre-dilution methods equally have advantages and disadvantages, therefore we should choose the more favorable one for clinical use. However, it still remains controversial which technique is better in on-line HDF. In post-dilution, the clearances of small molecular uremic toxins increase as well as low molecular proteins, however the risk of albumin leakage caused by high transmembranous pressure (TMP) also increases. We can avoid the risk of albumin leakage because there are several maneuvers which aid in avoiding an increase of TMP, such as glucose infusion and gradual control of Q<sub>f</sub>. On the other hand, the pre-dilution method is rather safe in the risk of albumin leakage but has an obvious clearance loss of small molecular substances caused by a decreased dialysate flow rate. The influence of microbial contamination and acetate are rather severe in pre-dilution on-line HDF. These lines of evidence suggest that post-dilution on-line HDF is the best choice for treating chronic HD patients.

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          Most cited references 14

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          Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

           D Goodkin (2003)
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            Albumin is the major plasma protein target of oxidant stress in uremia.

            Patients with uremia are exposed to increased oxidative stress. Examination of the oxidation of individual plasma proteins may be useful in establishing specific pathways of oxidative stress in vivo and in determining functional consequences of oxidant stress exposure. We therefore examined oxidative modification of plasma proteins by carbonyl formation using Western blot immunoassay and enzyme-linked immunosorbent assay (ELISA) techniques in patients with chronic renal failure (CRF) and on chronic hemodialysis therapy (HD). Plasma was obtained from 25 HD, 20 CRF, and 20 healthy volunteers, derivatized with 2,4 dinitrophenylhydrazine (DNP) and electrophoresed on duplicate 4 to 12% gradient sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) gels, transferred to nitrocellulose, and stained for DNP for carbonyls and amido black for protein content. Data are recorded as DNP area/protein area and are reported in densitometry units. Total plasma carbonyls were determined by ELISA. Plasma albumin is substantially more oxidized in HD than in healthy volunteers (1.22 +/- 0.14 densitometry units vs. 0.60 +/- 0.08, P = 0.002). There were no significant differences in oxidation of plasma transferrin, immunoglobulin, and fibrinogen in HD versus healthy volunteers. In CRF patients, plasma albumin is more oxidized compared with normal volunteers (1.36 +/- 0.20 densitometry units vs. 0.94 + 0.08, P = 0.09). There were no differences in oxidation of plasma transferrin, fibrinogen, and immunoglobulin in CRF patients versus healthy volunteers. An increased plasma protein carbonyl concentration in CRF patients compared with healthy volunteers was confirmed by ELISA (0.31 +/- 0.07 vs. 0.04 +/- 0.01 nmol/mg protein (P = 0.001). Albumin is the major plasma protein target of oxidant stress in CRF and HD patients.
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              A new form of amyloid protein associated with chronic hemodialysis was identified as β2-microglobulin

               F Gejyo,  T Yamada,  S Odani (1985)
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                978-3-8055-7886-8
                978-3-318-01189-0
                0253-5068
                1421-9735
                2004
                January 2005
                27 January 2005
                : 22
                : Suppl 2
                : 49-54
                Affiliations
                Kidney and Dialysis Center, Yabuki Hospital, Yamagata, Japan
                Article
                81875 Blood Purif 2004;22(suppl 2):49–54
                10.1159/000081875
                15655324
                © 2004 S. Karger AG, Basel

                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.

                Page count
                Figures: 2, Tables: 3, References: 23, Pages: 6
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/81875
                Categories
                International Debate

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