Dialysers

PUREMA H (referred to as PES) is an innovative dialysis membrane for enhanced low-molecular-weight (LMW) protein removal. The purpose of the study was to prove whether its efficacy in hemodialysis (HD) matches that of online hemodiafiltration (HDF) with conventional high-flux membranes. In a prospective, randomized, cross-over study on eight maintenance dialysis patients, treatment efficacy of HD with PES was compared with online postdilution HDF with the two synthetic high-flux membranes polysulfone (referred to as PSU) and Polyamix (referred to as POX). Apart from the infusion of replacement fluid, which was set at 20% of the blood flow rate of 300 mL/min, operating conditions in HD and HDF were kept identical. Small solute and LMW protein plasma clearances as well as the reduction ratio (RR) of cystatin C and retinol-binding protein were not different between the therapies. HDF with POX resulted in a significantly lower myoglobin RR as compared with HD with PES, and HDF with PSU. A 4% higher beta(2)-microglobulin RR was determined in HDF with PSU (73 +/- 5%) as compared with PES in HD (69 +/- 5%). The albumin loss was below 1 g for all treatments. Despite the fact that simple HD did not fully exploit the characteristics of PES, it achieved essentially similar LMW protein removal and albumin loss as compared with online postdilution HDF with the conventional synthetic high-flux membranes PSU and POX. Therefore, HD with PES may have beneficial effects on the outcome of maintenance dialysis patients similar to high-efficiency HDF.

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“…During sampling, Q UF was maintained. Q UF was taken into account for calculation of the whole blood K solute () (13):…”

Section: Methodsmentioning

confidence: 99%

Matching Efficacy of Online Hemodiafiltration in Simple Hemodialysis Mode

et al. 2008

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“…In spite of the efforts and the accumulation of the present clinical and technical skills, we still see progressive deterioration of function in several organ systems in critically ill intensive care ARF patients. The resulting syndrome with multiple organ failure (e.g., due to sepsis) is presently the main cause of death in surgical and trauma patients under intensive care [7], Until the late 1970s, treatment of renal failure by the artificial kidney did mean HD [8]. Over the last 15 years, this concept has changed.…”

Section: Discussionmentioning

confidence: 99%

Continuous Arteriovenous Hemodialysis: Outcome in Intensive Care Acute Renal Failure Patients

Alarabi¹,

Danielson²,

Wíkström³

1993

Nephron

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The clinical outcome of continuous arteriovenous hemodialysis (CAVHD), an alternative to continuous arteriovenous hemofiltration (CAVH) in our intensive care units (ICU) in Uppsala, was evaluated for 2 years. Forty-three patients were included. Pretreatment serum urea and creatinine levels (mean ± SD) were 36 ± 13 mmol/land 420 ± 147 μmol/l and during treatment, steady-state levels were 25 ± 10 mmol/land 333 ± 120 μmol/l respectively (p < 0.0001). On top of acute renal failure (ARF), some patients had multiple organ failure that made it necessary to use mechanical respiration (63%), vasopressor drugs (74%) and aortic balloon pump therapy (5%). The outcome of this treatment was 60% when overall survival was considered. Higher dialysate flow rates (i.e., 25 ml/min) were applied in some patients in whom serum urea levels were persistently rising. The result of this was a notable decrease in the urea and creatinine serum levels. From the results of this 2-year experience, we have found CAVHD a promising alternative to CAVH that can be used as a treatment of choice for ARF in critically ill ICU patients.

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