Long-Term Results of Regular Hemofiltration

Abstract

Long-term survival and morbidity in regular hemofiltration treatment is evaluated in two groups of patients with chronic renal insufficiency bearing different categories of risk. In one group of patients with low-risk (restriction of age, exclusion of diabetes mellitus and vascular diseases), complications during regular hemofiltration treatment (115 patients, 5,196 patient months) are compared to those of regular hemodialysis treatment (132 patients, 6,690 patient months). In a second group of patients with ‘high-risk’ (inclusion of diabetic nephropathy and cerebro- or cardiovascular diseases), hemofiltration (57 patients, 1,428 patient months) is compared to continuous ambulatory peritoneal dialysis (CAPD; 68 patients, 1,464 patient months). Long-term survival rates (8 years in the first and 5 years in the second group) did not show significant differences for hemofiltration and hemodialysis in the first group or for hemofiltration and CAPD in the second one. Main reasons for death in both groups were cardiovascular or cerebrovascular complications, and in the CAPD group infections (peritonitis, pneumonia), being similarly significant. Important differences between hemofiltration and hemodialysis on the one hand, and hemofiltration and CAPD on the other, could be demonstrated concerning morbidity, expressed in days of hospitalization per months of treatment. Hypotension, cardiovascular and cerebrovascular diseases, especially, necessitated significantly less frequent hospitalization of hemofiltration patients than of hemodialysis or CAPD patients; main reasons for hospitalization of hemodialysis patients being fistula complications and hypertension and for CAPD patients being infection, cardiac insufficiency, cerebrovascular disease and hypotension. In the second group, the frequency of complications of diabetes mellitus (retinopathy, angiopathy) was significantly higher in hemofiltration than in CAPD treatment. As has been shown earlier for short-term treatment, hemofiltration may exhibit its main advantage over hemodialysis in patients suffering from vascular complications also with long-term observation, thus ameliorating the quality of treatment.

On-Line Predilution Hemofiltration versus Ultrapure High-Flux Hemodialysis: A Multicenter Prospective Study in 23 Patients

“…Several benefits of hemofiltration (HF) over hemodialysis (HD), for example better cardiovascular stability [1][2][3], lower morbidi ty [4,5], higher survival rate in high-risk patients [6,7] and better removal of high molecular weight metabolites such as (T-microglobulin [8,9], have been well documented in the literature. In spite of this HF is used only to a limited extent.…”

Clinical and Microbiological Evaluation of a Postdilutional Hemofiltration System with In-Line Production of Substitution Fluid

“…In spite of the potential advantages of hemofiltration (HF), the clinical use of this blood purification technique as an alterna tive to conventional hemodialysis has been hampered either by the cost of pharmaceuti cally available substitution fluid or by the complexity of on-site batch preparation of substitution fluid [1][2][3][4][5][6][7]. To overcome these problems, a new HF system was recently developed with continuous in-line substitu tion fluid production, based on sterilizing fil tration (GHS-10; Gambro, Lund, Sweden) [8].…”

Prostacyclin (Epoprostenol) as the Sole Antithrombotic Agent in Postdilutional Hemofiltration

“…High-flux postdilutional hemofiltration (HF) has been described as an attractive alternative for the treat ment of uremic patients and as having potential advan tages as compared to conventional hemodialysis (HD) [1][2][3][4][5]. HF is associated with a greater cardiovascular sta bility due to better adaptation of peripheral vascular resistances [6] and thereby permitting reduction of treat ment time [7].…”