Measurement of Vascular Access Flow by Online Clearance Monitor in Online Hemodiafiltration

Tiranathanagul, Khajohn; Susantitaphong, Paweena; Towannang, Piyaporn; Injan, Patcharin; Praditpornsilpa, Kearkiat; Eiam‐Ong, Somchai

doi:10.1159/000327608

Cited by 5 publications

(4 citation statements)

References 45 publications

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“…In our study, the blood flow rate was adjusted to have an average of 250 mL/min. On-line HDF mode was selected for pre-dilution hemodiafiltration due to its previously described advantages (Tiranathanagul et al, 2011;Maduell, 2015;Albalate Ramón et al, 2015;Akizawa and Koiwa, 2015).…”

Section: Methodsmentioning

confidence: 99%

Seven-year Survival Rate of On-line Hemodiafiltration

Yoon

Kim

2019

BSL

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Conventional high-flux hemodialysis (HD) is not as good as normal kidney function. Morbidity and mortality rates of patients receiving HD are still very high. To increase mid-to-large molecule clearance by combining diffusion and convection, on-line hemodiafiltration (HDF) is required. The objective of this study was to compare long-term survival rate of patients treated with on-line HDF to those who received conventional high-flux HD by reviewing data from Chonnam National University Hospital (CNUH). We selected patients who attended the 'CUNH dialysis center' and agreed to participate in the study. Overall, 40 patients with ESRD switched from high flux HD to on-line HDF or started on-line HDF from August 2007 to December 2009. Additionally, a total of 42 patients receiving conventional high-flux HD during the same period were enrolled. We then reviewed long-term survival rate of patients receiving on-line HDF over the next seven years. When we compared survival rates for seven years, the survival rate of the group receiving on-line HDF was 65% (26/40) while that of the group receiving the conventional high-flux HD was 54.8% (23/42). Although the number of patients was small to see survival difference clearly by one specific dialysis modality, there was somewhat difference in survival rate between the two groups. Indicators such as anemia, calcium-phosphate metabolism, nutritional status, treatment adequacy, and hospitalization were also improved in the group receiving HDF. Overall, results of our study showed beneficial effects of on-line HDF on clinical outcomes and survival in chronic HD patients.

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Section: Methodsmentioning

confidence: 99%

Seven-year Survival Rate of On-line Hemodiafiltration

Yoon

Kim

2019

BSL

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“…Lastly, even considering the higher costs of Supra-HFR compared to OL-HDF (about 50 €/session vs. 25 €/session, respectively), it should be underlined that Supra-HFR can represent a valid option in some cases, because it can overcome the limitations arising from a malfunctioning vascular access (35)(36)(37).…”

Section: Supramentioning

confidence: 99%

Efficacy of Supra-HFR in Removing FGF23 and Cytokines: A Single Session Analysis

Donati

Angeletti

Cappuccilli

et al. 2022

In Vivo

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Background/Aim: Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) is a dialysis technique used to improve uremic toxin removal in the range of the middle molecular weight molecules. Supra-HFR does not require the preparation and online infusion of highpurity dialysis water because it allows the production of an endogenous ultrafiltrate that undergoes detoxification through an adsorbing resin. Patients and Methods: We investigated the ability of Supra-HFR to remove fibroblast growth factor 23 (FGF23), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFalpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha) after a single session dialysis in nine patients affected by end stage renal disease (ESRD). The same patients underwent a single session of online hemodiafiltration (OL-HDF) to evaluate possible differences in FGF23 and IL-6 levels. Results: A significant reduction in FGF23 was observed with both Supra-HFR (p=0.001) and OL-HDF. As for TNF-alpha and TGF-alpha, which were measured using Supra-HFR only, their percentage values were significantly lower at the end of dialysis than at the start (p=0. 0028 and p=0.03, respectively). This did not change with post-dialysis rebound. Supra-HFR was found to have no effect on IL-6 and IL-8. Interestingly, the removal rate for FGF23 and IL-6 was similar to that observed with OL-HDF. Conclusion: Supra-HFR was not superior to OL-HDF, with suboptimal convective volume in the removal of the molecules tested, especially FGF23, which is considered a large middle molecular weight uremic toxin.Online hemodiafiltration (OL-HDF) combines diffusive and convective clearance of uremic toxins, thus allowing a markedly enhanced removal of middle molecular weight molecules. For this reason, it has been associated with better cardiovascular outcomes than standard hemodialysis (1-7). However, several pre-conditions need to be met to perform an effective OL-HDF, and not all hemodialysis patients are eligible for this treatment. Two main reasons prevent a broader application of OL-HDF: i) an inadequate vascular access (when blood flow is below 350 ml/min) (7); ii) a water treatment system unable to provide ultrapure water (8). Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) seems to be a valid alternative, as it has been reported to effectively remove middle molecular weight uremic toxins without albumin loss and without the need of preparing and online infusion of high-purity dialysis fluid. However, despite encouraging data, additional studies are needed to confirm these findings (9-12).The present study evaluated the efficacy of a single session of Supra-HFR in terms of removal of fibroblast growth factor 23 (FGF23) and inflammatory markers in the range of middle molecular weight molecules, namely interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha). After 1769

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“…The correlation coefficient between access flow rate measured by ionic dialysance and ultrasound dilution (HD01 monitor, Transonic Systems Inc, Ithaca, NY, USA) considered as gold standard is reported as about 0.9 for the Diascan 55,56 . For the OCM, the correlation coefficient is in a very wide range (0.58–0.95) because it depends on the type of Fresenius hemodialysis monitor 57‐60 . This could be due to the fact that the OCM for the US market is different from that of the European market with respect to the dialysate conductivity profile imposed at the dialyzer inlet 61 .…”

Section: Impact Of a Change In Urea Clearancementioning

confidence: 99%

Routine online assessment of dialysis dose: Ionic dialysance or UV‐absorbance monitoring?

Petitclerc

Ridel

2021

Seminars in Dialysis

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For three‐weekly hemodialysis, a single‐pool Kt/V target of at least 1.4 together with a minimal dialysis dose Kt at 45 L for men and 40 L for women per each session is currently recommended. Fully automatic online calculation of Kt and Kt/V from conductivity or UV‐absorbance measurements in the dialysate is standardly implemented on some hemodialysis monitors and makes it possible to estimate the dialysis dose without the need for blood or dialysate samples. Monitoring the UV‐absorbance of the spent dialysate is the most direct method for estimating Kt/V as it does not require an estimate of V. Calculation of ionic dialysance from conductivity measurements is the most direct method for estimating Kt and BSA‐scaled dialysis dose. Both ionic dialysance monitoring and UV‐absorbance monitoring may help detect a change in urea clearance occurring during the session, but this change must be interpreted differently depending on the monitoring being considered. An abrupt decrease in urea clearance results in a decrease in ionic dialysance but, paradoxically, a sudden increase in estimated urea clearance provided by dialysate UV‐absorbance monitoring. Healthcare teams who monitor both ionic dialysance and UV‐absorbance in their hemodialysis units must be clearly informed of this difficulty.

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Measurement of Vascular Access Flow by Online Clearance Monitor in Online Hemodiafiltration

Cited by 5 publications

References 45 publications

Seven-year Survival Rate of On-line Hemodiafiltration

Seven-year Survival Rate of On-line Hemodiafiltration

Efficacy of Supra-HFR in Removing FGF23 and Cytokines: A Single Session Analysis

Routine online assessment of dialysis dose: Ionic dialysance or UV‐absorbance monitoring?

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