Comparison of the pre-dilution and post-dilution methods for online hemodiafiltration

Kawai, Yusuke; Maeda, Kazuya; Moriishi, Misaki; Kawanishi, Hideki; Takao, Masaki

doi:10.1007/s10047-023-01391-2

“…To the best of our knowledge, there are no studies comparing all high-efficiency dialysis modalities in the context of intradialytic tolerance. Individual small studies comparing PRE-HDF only in relation to POST-HDF and HDx and did not show any differences [39][40][41]. Our study seems to be pioneering in this respect, especially if we take into account the population in which the study was conducted.…”

Section: Discussionmentioning

confidence: 73%

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

Zakrzewska,

Biedunkiewicz,

Komorniczak

et al. 2023

Preprint

0

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There are several forms of maintenance high-efficiency hemodialysis (HD) including hemodiafiltrations (HDF) in different technic modes and expanded HD using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, cross-over study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialysis in random order: high flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). 24 dialysis sessions of each method were included in the analysis. Dialysis parameters including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) l, respectively. During all therapies, patients had similar hydration status monitored using bioimpedance spectroscopy and similar variability over time in systemic blood pressure, cardiac output, and peripheral resistance monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance, however the study results suggest that, intradialytic tolerance and DRT may depend on the dialysis method used. This support the need of taking into account patient preferences and quality of life while individualizing high efficiency therapy in HD patients.

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“…There are no similar studies comparing all high-efficiency dialysis modalities in this regard. Individual small studies comparing PRE-HDF in relation to POST-HDF and HDx in relation to POST-HDF did not show any differences in terms of dialysis tolerance [41][42][43]. Importantly, taking into account parameters of hemodynamic stability (Figure 1 and Figure 2) POST-HDF should be favored over other methods, explaining the long term benefits of this method in CONVINCE study.…”

Section: Resultsmentioning

confidence: 86%

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

Zakrzewska,

Biedunkiewicz,

Komorniczak

et al. 2023

Preprint

0

View full text Add to dashboard Cite

There are several forms of maintenance high-efficiency hemodialysis (HD) including hemodiafiltrations (HDF) in different technic modes and expanded HD using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, cross-over study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialysis in random order: high flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). 24 dialysis sessions of each method were included in the analysis. Dialysis parameters including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) l, respectively. During all therapies, patients had similar hydration status monitored using bioimpedance spectroscopy and similar variability over time in systemic blood pressure, cardiac output, and peripheral resistance monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance, however the study results suggest that, intradialytic tolerance and DRT may depend on the dialysis method used. This support the need of taking into account patient preferences and quality of life while individualizing high efficiency therapy in HD patients.

show abstract

“…To the best of our knowledge, there are no studies comparing all high-efficiency dialysis modalities in the context of intradialytic tolerance, only individual small studies comparing PRE-HDF, only in relation to POST-HDF and HDx, and did not show any differences [39][40][41]. Our study seems to be pioneering in this respect, especially if we take into account the population in which the study was conducted.…”

Section: Discussionmentioning

confidence: 82%

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

Zakrzewska,

Biedunkiewicz,

Komorniczak

et al. 2024

JCM

1

0

View full text Add to dashboard Cite

There are several forms of maintenance high-efficiency hemodialysis (HD), including hemodiafiltrations (HDF) in different technical modes and expanded HD, using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, crossover study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialyses in random order: high-flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). Twenty-four dialysis sessions of each method were included in the analysis. Dialysis parameters, including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) L, respectively. During all therapies, patients were monitored for the similarity of their hydration statuses using bioimpedance spectroscopy, and for similar variability over time in systemic blood pressure and cardiac output, while peripheral resistance was monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance; however, the study results suggest that intradialytic tolerance and DRT may depend on the dialysis method used. This supports the need of taking into account patient preferences and quality of life while individualizing high-efficiency therapy in HD patients.

show abstract

Comparison of the pre-dilution and post-dilution methods for online hemodiafiltration

Cited by 3 publications

References 40 publications

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities

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