New strategies in haemodiafiltration (HDF): prospective comparative analysis between on-line mixed HDF and mid-dilution HDF

Abstract

Mixed HDF was the most efficient technique in the highest range of safe operating conditions. In mid-dilution HDF, high pressures generated inside the dialyser compromised membrane permeability and limited the total infusion rate, resulting in an overall reduction in solute removal.

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

“…Two kinds of MIXED are currently proposed [7]. The first on the market was mid-dilution ol-HDF (MID) [8,9,10].…”

Phosphate Elimination in Modalities of Hemodialysis and Peritoneal Dialysis

“…Mixed-dilution HDF is a relatively new modality where blood dilution is split between pre-and postfiltering and which was developed to achieve the best possible rheological and hydraulic conditions within the dialyzer and to optimize the fluid exchange rate and convective solute removal. However, a significant advantage of mixed-dilution over postdilution HDF in regard of P i removal still needs to be demonstrated [12] . Mixed dilution may be of special advantage in patients with high predialysis hematocrit and an increased risk of filter clotting with postdilution HDF due to hemoconcentration.…”

New strategies in haemodialfiltration (HDF)--prospective comparative analysis between online mixed HDF and mid-dilution HDF

“…Sir, The report by Feliciani et al [1] on the comparison of online mixed haemodialfiltration (HDF) and mid-dilution HDF caused several concerns as to the validity of their results. Their decision, which was based on a misinterpretation of our own, earlier published work [2], not attempting to optimize anti-coagulation for mid-dilution HDF, may have resulted in insufficient heparin dosing and, subsequently, in very high pressures and reduced clearances, due to increasingly clotting of fibers.…”

“…According to our findings and experience, mid-dilution HDF with the Nephros MD220 filter is a safe and highly effective therapy mode, provided that adequate operating conditions have been chosen. Reply Sir, In a comparative study of two online haemodiafiltration techniques, published in NDT [1], we reported that, in middilution HDF, impressive high hydraulic pressures were recorded in the first section of the blood dialyser compartment, where post-dilution takes place. Scepticism on the validity of these findings, recently expressed by Krieter and Canaud in NDT [2], lies on the feeling that insufficient anti-coagulation caused partial fibre clotting and compromised the efficiency of our experimental sessions.…”