Mixed predilution and postdilution online hemodiafiltration compared with the traditional infusion modes

Pedrini, Luciano A.; Cristofaro, Vincenzo De; Pagliari, B; Samà, F

doi:10.1111/j.1523-1755.2000.00389.x

Cited by 73 publications

(28 citation statements)

References 31 publications

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“…During post-dilution HDF, ultrafiltration favors hemoconcentration, which alters intradialyzer blood rheology. These changes may impede convective transport capacity by increasing in- and post-filter viscosity, leading to fiber clotting and pressure alarms [26]. A high serum albumin may promote plasma refilling during treatment, thus allowing higher ultrafiltration rates.…”

Section: Discussionmentioning

confidence: 99%

Treatment Policy rather than Patient Characteristics Determines Convection Volume in Online Post-Dilution Hemodiafiltration

Chapdelaine

Mostovaya²,

Blankestijn

et al. 2014

Blood Purif

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Background/Aims: Sub-analyses of three large trials showed that hemodiafiltration (HDF) patients who achieved the highest convection volumes had the lowest mortality risk. The aims of this study were (1) to identify determinants of convection volume and (2) to assess whether differences exist between patients achieving high and low volumes. Methods: HDF patients from the CONvective TRAnsport STudy (CONTRAST) with a complete dataset at 6 months (314 out of a total of 358) were included in this post hoc analysis. Determinants of convection volume were identified by regression analysis. Results: Treatment time, blood flow rate, dialysis vintage, serum albumin and hematocrit were independently related. Neither vascular access nor dialyzer characteristics showed any relation with convection volume. Except for some variation in body size, patient characteristics did not differ across tertiles of convection volume. Conclusion: Treatment time and blood flow rate are major determinants of convection volume. Hence, its magnitude depends on center policy rather than individualized patient prescription.

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Section: Discussionmentioning

confidence: 99%

Treatment Policy rather than Patient Characteristics Determines Convection Volume in Online Post-Dilution Hemodiafiltration

Chapdelaine

Mostovaya²,

Blankestijn

et al. 2014

Blood Purif

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“…It is not dialyzer-dependent but depends on the 5008 dialysis machine. Its main principle [12,13,14] is to make Q s Pre and Q s Post strictly depend on a preselected TMP range between two limits not to be exceeded. Given the more positive TMP influence of PostD vs. PreD, one can predict a Q s Pre increase with a Q s Post decrease when TMP reaches its upper limit and inversely when it reaches its lower one.…”

Section: Discussionmentioning

confidence: 99%

Elevated Removal of Middle Molecules without Significant Albumin Loss with Mixed-Dilution Hemodiafiltration for Patients Unable to Provide Sufficient Blood Flow Rates

Potier¹,

Roy

Faucon³

et al. 2013

Blood Purif

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Background: We examined the hypothesis that mixed-dilution online hemodiafiltration (MIXED) rather than predilution online hemodiafiltration (PRE) could enable patients with low blood flow rate (Q_b) to benefit from advantages of convective therapies. Methods: Thirty-eight patients were included in a prospective, randomized, crossover and multicenter study conducted with a view to comparing the equilibrated Kt/V, reduction ratio (RR) of phosphates, β₂-microglobulin (β₂-M) and myoglobin (myo) between PRE and MIXED, each at two Q_b values of 250 and 300 ml/min during 4 h sessions with a FX1000HDF dialyzer. Albumin losses (Alb) were also measured in 12 patients. Results: MIXED was always found to be more efficient compared to PRE notably for middle molecules (MM). RRβ₂-M: MIX250: 81.3 ± 3.6 vs. PRE250: 75.2 ± 5.9; MIX300: 82.7 ± 3.6 vs. PRE300: 78.1 ± 5.4; RRmyo: MIX250: 70.2 ± 3.6 vs. PRE250: 42.6 ± 2.6; MIX300: 70.6 ± 3.6 vs. PRE300: 45.7 ± 3.6 and with Alb <3.0 g/session. Conclusion: MIXED allows patients unable to provide sufficiently high Q_b to achieve high levels of MM removal.

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“…Ischemic syndrome in physiological conditions results from a fall in blood pressure in the periphery and failure of compensatory vasodilatation [16] . Heart failure in HD patients has a multifactorial character [14,[17][18][19] . We found an important trend concerning the incidence of cardiovascular disease in the patients with DHIS, most likely due to expressed atherogenesis in the HD patients.…”

Section: Hemodynamic Impact On the Development Of Distal Ischemiamentioning

confidence: 99%

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Stolić¹

2013

WJN

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AIM:To determine survival parameters as well as characteristics of patients with this syndrome. METHODS:The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died. RESULTS:Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). KaplanMeier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e. , patients with confirmed digital hypoperfusion ischemic syndrome died earlier. CONCLUSION:Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.© 2013 Baishideng. All rights reserved.Key words: Digital hypoperfusion ischemic syndrome; Predictive parameters; Survival; Arteriovenous fistula; Hemodialysis Core tip: In order to prevent the occurrence of distal hypoperfusion syndrome, is important identification of risk factors. Problem is the absence of objective indicators of distal ischemia, which is main reason why large proportion our patients have of this symptoms. Our patients with these symptoms were significantly older, which confirms older age as a factor that characterizes BRIEF ARTICLE 26May 6, 2013|Volume 2|Issue 2| WJN|www.wjgnet.com patients with distal hypoperfusion syndrome. We have confirmed greater incidence of diabetes mellitus and smokers among the patients with distal hypoperfusion syndrome. Quality of dialysis, diabetes mellitus, erythropoietin therapy, smokers and hemodiafiltration has predictive value for survival of patients with distal ischemia.Stolic RV, Trajkovic GZ, Miric DJ, Kisic B, Djordjevic Z, Azanjac GL, Stanojevic MS, Stolic DZ. Arteriovenous fistulas and digital hypoperfusion ischemic ...

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Mixed predilution and postdilution online hemodiafiltration compared with the traditional infusion modes

Cited by 73 publications

References 31 publications

Treatment Policy rather than Patient Characteristics Determines Convection Volume in Online Post-Dilution Hemodiafiltration

Treatment Policy rather than Patient Characteristics Determines Convection Volume in Online Post-Dilution Hemodiafiltration

Elevated Removal of Middle Molecules without Significant Albumin Loss with Mixed-Dilution Hemodiafiltration for Patients Unable to Provide Sufficient Blood Flow Rates

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

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