On‐line haemodiafiltration. Safety and efficacy in long‐term clinical practice

Canaud, Bernard; Bosc, J. Y.; Leray‐Moragues, Hélène; Stec, F.; Argilés, Àngel; Leblanc, Martine; Mion, C

doi:10.1093/oxfordjournals.ndt.a027966

Cited by 62 publications

(49 citation statements)

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“…The cold sterilization filtration process of dialysis fluids (dialysate and infusate) enabled by online sterilizing filters offers a safe and affordable way of producing large amounts of substitution fluid for HDF modalities [2,3]. OL-HDF machines have the advantages of being certified by European-notified bodies and recognized by EBPG [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

Emerging Clinical Evidence on Online Hemodiafiltration: Does Volume of Ultrafiltration Matter?

Canaud

Bowry

2013

Blood Purif

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Online hemodiafiltration (OL-HDF), first described in 1985, is today a widely prescribed treatment modality for end-stage chronic kidney disease (CKD) patients. Other than in the United States, prescription of the treatment modality is widespread with a steady increase since its inception. Indeed, in Western Europe, more CKD patients receive OL-HDF than peritoneal dialysis, hitherto the second most prescribed therapy after conventional hemodialysis. The rise and success of OL-HDF can be attributed to diverse clinical advantages that have been documented over the last two decades. Numerous publications attest to the beneficial effects of OL-HDF in terms of removal of a broad spectrum of uremic toxin, anemia control, phosphate reduction, increased hemodynamic stability and blood pressure control and less dialysis-related amyloidosis, to mention just a few. Significantly, the improvement in these conditions is considered to contribute to improved patient outcomes. Despite the extended worldwide clinical experience, elaborate scientific validation of the principles of the therapy and technical innovations that facilitate its prescription, a point of contention is whether OL-HDF leads to a reduction of mortality rates. A number of observational and retrospective analyses have indicated a survival benefit, while prospective investigations involving small numbers of patients but nevertheless specifically addressing survival have further supplied evidence of improved survival with OL-HDF. The quest for large-scale, multicenter prospective randomized controlled trials examining patient survival led to the CONTRAST and the Turkish OL-HDF trials. Both trials have been concluded and published recently. In this chapter, we document and assess the key investigations that have examined the impact of OL-HDF on patient outcome and survival. Based on the findings of previous analyses and of the two recently concluded trials, it appears that the volume of convection appears to be decisive towards the survival benefit accredited to OL-HDF. We consider the implications of this new evidence.

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Section: Introductionmentioning

confidence: 99%

Emerging Clinical Evidence on Online Hemodiafiltration: Does Volume of Ultrafiltration Matter?

Canaud

Bowry

2013

Blood Purif

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“…On-line therapies, such as on-line HDF, are an RRT based upon the use of ultrapure dialysis fluid, allowing the production of an infusate by further filtration to ensure quality requirements for a sterile and pyrogen-free infusion solution. In chronic dialysis facilities, this technique became a routine and safe modality of RRT and now represents the most effective dialysis therapy [12,13,14,15]. However, few reports exist about its use in ICUs, and its routine application is mainly restricted to ICU facilities working with a trained nephrological team [9,10,11,16,17,18,19].…”

mentioning

confidence: 99%

Implementing On-Line Hemodiafiltration as a Renal Replacement Therapy for ICU Acute Renal Failure: A Single-Center Report of Feasibility, Safety and Hemodynamic Tolerance over a Seven-Year Period

Klouche¹,

Amigues²,

Serveaux-Delous³

et al. 2012

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Background/Aims: On-line hemodiafiltration (HDF) is not yet routinely used in ICUs given the potential risk of microbial contamination of dialysis fluids. We evaluated the safety and the tolerance of its use in our ICU. Methods: A weekly measurement of bacterial growth (CFU/ml) and endotoxin level (endotoxin units/ml) was performed in dialysis fluids over a 7-year period. Intradialytic hypotensive events and pyrogenic reactions were collected during 466 on-line HDF sessions. Results: A bacterial count <0.1 CFU/ml was achieved in 977/978, 288/290, and 278/280, and an endotoxin level <0.03 endotoxin units/ml in 564/576, 330/337 and 318/323 ultrapure water, dialysate, and infusate samples, respectively. Seventy-six intradialytic hypotensive events but no pyrogenic reaction occurred. Conclusion: The great majority of dialysis fluid samples were considered suitable with a 99% compliance rate. Use of on-line HDF, at a large scale of dialysate and infusate flows, is well tolerated and may be safely performed in critically ill.

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“…Whereas conventional hemodialysis eliminates mostly small molecular weight uremic toxins by diffusion, hemodiafiltration has the advantage of eliminating higher molecular weight toxic polypeptides by convective transport. In comparison to hemodialysis, the quality of life is superior and mortality rates are lower in the case of hemodiafiltration [8][9][10]. Moreover despite the huge changes with regard to volume status the quality of life is improved and mortality rates are lower in the case of hemodiafiltration.…”

Section: Introductionmentioning

confidence: 99%

Hemodiafiltration beneficially affects QT interval duration and dispersion compared to hemodialysis

et al. 2014

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On‐line haemodiafiltration. Safety and efficacy in long‐term clinical practice

Cited by 62 publications

References 1 publication

Emerging Clinical Evidence on Online Hemodiafiltration: Does Volume of Ultrafiltration Matter?

Emerging Clinical Evidence on Online Hemodiafiltration: Does Volume of Ultrafiltration Matter?

Implementing On-Line Hemodiafiltration as a Renal Replacement Therapy for ICU Acute Renal Failure: A Single-Center Report of Feasibility, Safety and Hemodynamic Tolerance over a Seven-Year Period

Hemodiafiltration beneficially affects QT interval duration and dispersion compared to hemodialysis

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