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

Krieter, Detlef H.; Canaud, Bernard

doi:10.1093/ndt/gfm604

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…With respect to these larger molecules, only Krieter et al [7] reported RBP reduction rates, approximately 22% in mid-dilution (Qi 200 ml/min) and 13% in postdilution (Qi 100 ml/min). In our study and that of Krieter et al [7] , the low RBP (21.2 kDa) reduction ratio values (lower than 30%) obtained in comparison with myoglobin (17.2 kDa) and prolactin (23.0 kDa) reduction ratio values (higher than 50%) could be due to the fact that RBP is a protein-bound solute [16,17] . For this reason, RBP should be reconsidered as a marker of efficiency of dialyzers and procedures.…”

Section: Discussionsupporting

confidence: 56%

Mid-Dilution Hemodiafiltration: A Comparison with Pre- and Postdilution Modes Using the Same Polyphenylene Membrane

et al. 2009

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As a change from Diapes to polyphenylene membrane in the mid-dilution filter has recently been developed, the aim of this study was to compare mid-dilution using this new dialyzer versus pre- and postdilution. The prospective study included 20 patients who underwent 4 hemodiafiltration (HDF) sessions: 1.7 m² polyphenylene and predilution infusion flow (Qi) 200 ml/min, 1.7 m² and postdilution Qi 100 ml/min, 1.9 and 2.2 m² mid-dilution both with Qi 200 ml/ min. The urea and creatinine reduction ratios were slightly higher in postdilution. The β₂-microglobulin (85.8%), myoglobin (73.6%), prolactin (67.8%) and retinol-binding protein (29.2%) reduction ratios with 1.9 m² mid-dilution, which was similar to 2.2 m² mid-dilution, were significantly higher than with the post- and predilution modes. Mid-dilution appears to be a good HDF alternative that allows a better removal of larger molecules than postdilution and, mainly, predilution. Mid-dilution using 1.9 or 2.2 m² dialyzers, at the same convective volume, showed a similar removal.

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Section: Discussionsupporting

confidence: 56%

Mid-Dilution Hemodiafiltration: A Comparison with Pre- and Postdilution Modes Using the Same Polyphenylene Membrane

et al. 2009

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“…(14) demonstrated the greater efficacy of the original mixed‐dilution when compared with the original mid‐dilution, they had to confront high pressures inside the dialyzer and the limited total infusion rate, resulting in an overall solute removal reduction in the original mid‐dilution OL‐HDF. As the unique blood flow‐path configuration of the Nephros MD 190 filter is very sensitive to clotted fibers that is bolstered via the ultrafiltration effect from convective clearance, therefore, optimized anticoagulation for the original mid‐dilution OL‐HDF should be a concern (26). The reverse mid‐dilution or increased surface area in the MD‐220 filter might solve this clotting problem and provide better clearance efficacy (27,28).…”

Section: Discussionmentioning

confidence: 99%

Efficacy Comparison Between Simple Mixed‐Dilution and Simple Mid‐Dilution On‐Line Hemodiafiltration Techniques: A Crossover Study

Susantitaphong

Tiranathanagul²,

Katavetin³

et al. 2012

Artificial Organs

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Mid-dilution and mixed-dilution on-line hemodiafiltration (OL-HDF) techniques are innovated to overcome the limitations of two standard techniques including predilution and postdilution. Unfortunately, the head-to-head comparisons between these two novel techniques in the same study are still limited. Moreover, the original mid-dilution and mixed-dilution OL-HDF need special dialyzers and special machines. In the present study, simple mid-dilution and simple mixed-dilution OL-HDF were settled with the aim for clinical use in general hemodialysis (HD) centers. The efficacies of uremic toxins removal between both modalities were measured and compared. This prospective randomized crossover study was conducted on 12 stable HD patients undergoing simple mixed-dilution and simple mid-dilution OL-HDF techniques. HD prescriptions were similar in both techniques. The dialysis efficacies were determined by calculating small- (urea, creatinine, and phosphate) and middle-molecule (beta-2 microglobulin [β2M]) removal. Moreover, potential complications such as high transmembrane pressure (TMP) and protein loss were also observed. Simple mixed-dilution OL-HDF provided significantly greater clearances of urea, creatinine, and β2M when compared with the simple mid-dilution OL-HDF techniques. Phosphate clearances in both techniques were comparable. In addition, TMP and dialysate albumin loss were not different. There were no intradialytic complications in both techniques. Simple mixed-dilution OL-HDF could provide greater efficacy for small- and middle-molecule clearances and acceptable potential risks, while phosphate removal is comparable.

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“…Reversal of the configuration of the blood tubing (i.e. connecting the arterial line to the venous port of the dialyser and vice versa) has been successfully trialled in mid-dilution HDF without significant effect on plasma clearances if adequate infusion rates are maintained [32,33]. Consideration should also be given to the use of larger-surface filters (e.g.…”

Section: Mid-dilution Hdfmentioning

confidence: 99%

Fluid Convection, Generation and Reinfusion in Haemodiafiltration

See¹,

Hawley²,

Agar³

et al. 2016

Advances in Hemodiafiltration

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Despite widespread use in clinical practice for over years, many questions remain unanswered regarding fluid convection and reinfusion strategies in haemodiafiltration HDF . Randomised controlled trials have failed to consistently demonstrate improved survival with convective therapies, but a dose-dependent improvement in outcome has been suggested. The minimum and ideal volumes of convection are undefined. Online generation of ultrapure dialysis fluid has allowed unprecedented convection volumes however, delivery of fluid directly into the blood circuit requires strict monitoring. The replacement fluid may be reinfused at multiple points in the circuit. Post-dilution HDF is highly efficient in terms of solute clearance but is limited by haemoconcentration. Predilution HDF prolongs filter life but requires significant convection volumes to achieve adequate solute clearance. Mid-dilution HDF utilises a specific dialyser, which is associated with additional cost and escalating transmembrane pressure. Mixeddilution HDF appears to offer an attractive balance between solute clearance efficiency and haemoconcentration, however these findings need to be confirmed in large studies. The majority of trials comparing fluid reinfusion strategies have enrolled small numbers of patients over brief study periods. It is unclear whether high-quality evidence examining fluid convection and reinfusion will become available and practice may need to rely on observational data.

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

Cited by 8 publications

References 4 publications

Mid-Dilution Hemodiafiltration: A Comparison with Pre- and Postdilution Modes Using the Same Polyphenylene Membrane

Mid-Dilution Hemodiafiltration: A Comparison with Pre- and Postdilution Modes Using the Same Polyphenylene Membrane

Efficacy Comparison Between Simple Mixed‐Dilution and Simple Mid‐Dilution On‐Line Hemodiafiltration Techniques: A Crossover Study

Fluid Convection, Generation and Reinfusion in Haemodiafiltration

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