Haemodiafiltration versus High-Flux Haemodialysis: Effects on Phosphate Control and Erythropoietin Response

Oates, Thomas; Pinney, Jennifer H.; Davenport, Andrew

doi:10.1159/000322834

Cited by 55 publications

(55 citation statements)

References 38 publications

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“…A high serum phosphate (P) level is an independent determinant of morbidity and mortality in HD patients, with values of 51.78 mmol/L considered to be the ideal target. 15,16 However, therapeutic intervention generally fails in about 50% of patients. Standard 4-hours HD allows the removal of about 800 mg P/session, that is, 2400 mg phosphorus in 1 week.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes for maintenance hemodialysis patients using a high-flux (FX60) dialyzer

Wang

et al. 2013

Renal Failure

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Aims: To investigate the clinical outcomes of maintenance hemodialysis (HD) patients using a high-flux (FX60) dialyzer. Method: Thirty patients undergoing dialysis for at least 2 years with a low-flux dialyzer were switched to the FX60 dialyzer for 3 years. Clinical and biochemical analysis was performed monthly for each patient. The parameters monitored included blood pressure, hemoglobin, albumin, intact parathyroid hormone (iPTH), calcium and phosphorus levels, the adequacy of dialysis (Kt/V), beta2-microglobulin (b2-MG) clearance rate, as well as antihypertensive and erythropoietin (EPO) medications. Results: After 3 years of dialysis with an FX60 dialyzer, the mean arterial blood pressure fell, hemoglobin increased, serum phosphate level decreased, iPTH declined and medication doses decreased. Conclusions: Dialysis with the FX60 dialyzer has a better clinical outcome for rectifying renal anemia, controlling hypertension and lowering serum phosphate levels making it a better choice for long-term HD patients.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes for maintenance hemodialysis patients using a high-flux (FX60) dialyzer

Wang

et al. 2013

Renal Failure

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“…Compared to many centres, we typically use lower calcium dialysates [30], and lower dialysate calcium concentrations have been reported to result in greater intradialytic cardiovascular instability [31]. …”

Section: Discussionmentioning

confidence: 99%

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

2011

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Introduction: Intradialytic hypotension remains the commonest complication of outpatient haemodialysis (HD) treatments. On-line haemodiafiltration (HDF) has been reported to reduce the frequency of intradialytic hypotension. We introduced on-line HDF into our satellite dialysis program, and prospectively audited the effect of HDF on cardiovascular stability. Methods: 34 patients’ dialysis schedules (Tuesday/Thursday/Saturday) were converted to online post-dilutional HDF, and 44 patients’ dialysis schedules (Monday/Wednesday/Friday) remained on high-flux HD. Blood pressure and intra-treatment complications were monitored prospectively for 12 months. Results: There was no significant change in pre-treatment mean arterial blood pressure in the HDF group during the 12 months of the study (pre-treatment 113.7 ± 0.7 mm Hg vs. 109.3 ± 2.8 after 12 months), or for the HD cohort (113.9 ± 2.7 vs. 117.9 ± 2.6). However, the frequency of intradialytic hypotensive episodes was greater for the HDF cohort: 25.9 versus 16.5% in the HD cohort, p = 0.0116. During HDF, on average >16 litres of substitution fluid was used and the median temperature was 36°C (35°C–36°C), higher than the dialysate in the HD cohort which was 35°C (35°C–36°C), p < 0.05. Conclusion: In this study, HDF did not improve blood pressure control or reduce the frequency of intradialytic hypotensive episodes compared to high-flux HD using cooled dialysate.

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“…In contrast to conventional hemodialysis treatments that rely almost solely on diffusion-related mechanisms for solute removal, HDF allows more efficient removal of higher molecular weight toxins due to convective transport mechanisms [1,2,3,4]. The decisive feature for the removal of larger uremic toxins in an HDF treatment mode is the use of efficient high-flux dialyzers that have membranes with elevated sieving coefficients for larger uremic retention solutes while simultaneously minimizing loss of albumin [5,6].…”

Section: Introductionmentioning

confidence: 99%

Elimination of Large Uremic Toxins by a Dialyzer Specifically Designed for High-Volume Convective Therapies

Maduell¹,

Arias‐Guillén²,

Fontseré³

et al. 2014

Blood Purif

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Background: Unlike conventional hemodialysis treatments, which rely almost solely on diffusion-related mechanisms for solute removal, hemodiafiltration (HDF) allows more efficient removal of higher molecular weight toxins due to convective transport mechanisms. To facilitate the removal of these toxins in HDF treatment modalities, dialyzers with highly efficient high-flux membranes are necessary. This study assessed the large uremic toxin removal ability of a high-flux dialyzer (FX CorDiax 60) specifically designed to facilitate convective therapies compared with a standard high-flux dialyzer (FX 60). Methods: In an open, randomized, cross-over, single-center, controlled, prospective clinical study, 30 adult chronic hemodialysis patients were treated by post-dilution online HDF with the FX 60 or the FX CorDiax 60 dialyzer. All other dialysis parameters were kept constant in both study arms. The reduction rate (RR) of blood urea nitrogen, phosphate, β₂-microglobulin (β₂-m), myoglobin, prolactin, α₁-microglobulin, α₁-acid glycoprotein, albumin and total protein as well as the elimination into dialysate was intraindividually compared for the two dialyzer types. Results: For FX CorDiax 60 versus FX 60, the RR was significantly higher for blood urea nitrogen (86.23 ± 4.14 vs. 84.89 ± 4.59%, p = 0.015), β₂-m (84.67 ± 3.79 vs. 81.30 ± 4.82%, p < 0.0001), myoglobin (75.23 ± 10.48 vs. 58.60 ± 12.1%, p < 0.0001), prolactin (72.96 ± 9.68 vs. 56.91 ± 13.01%, p < 0.0001) and α₁-microglobulin (20.89 ± 18.27 vs. 13.60 ± 12.50%, p = 0.016). There were no significant differences in the RR for phosphate, α₁-acid glycoprotein, albumin and total protein. Mass removal was significantly higher with the FX CorDiax 60 than with the FX 60 for β₂-m (0.26 ± 0.09 vs. 0.24 ± 0.09 g, p = 0.0006), myoglobin (1.83 ± 0.89 vs. 1.51 ± 0.76 mg, p = 0.0017), prolactin (0.17 ± 0.13 vs. 0.14 ± 0.08 mg, p = 0.02) and albumin (4.25 ± 3.49 vs. 3.01 ± 2.37 g, p = 0.03). Conclusions: This study demonstrates that treating patients with an FX CorDiax 60 instead of an FX 60 dialyzer in post-dilution HDF mode significantly increases the elimination of middle molecules.

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Haemodiafiltration versus High-Flux Haemodialysis: Effects on Phosphate Control and Erythropoietin Response

Cited by 55 publications

References 38 publications

Clinical outcomes for maintenance hemodialysis patients using a high-flux (FX60) dialyzer

Clinical outcomes for maintenance hemodialysis patients using a high-flux (FX60) dialyzer

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

Elimination of Large Uremic Toxins by a Dialyzer Specifically Designed for High-Volume Convective Therapies

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