Technical and Clinical Evaluation of Different Short, Highly Efficient Dialysis Techniques

Ronco, Claudio; Brendolan, Alessandra; Bragantini, L; Chiaramonte, S; Fabris, A; Feriani, M; Dell'Aquila, R; Milan, Massimo; Scabardi, M; Pinna,

doi:10.1159/000415235

Cited by 44 publications

(21 citation statements)

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“…Precise ultrafiltration control systems were required to modulate ultrafiltration in high surface area/highly permeable hemodialyzers. This led to the discovery of significant side effects due to the backfiltration of contaminated dialysate into the blood and clearly revealed the requirement of high water quality and powder concentrates to avoid contaminations [8]. Several studies focused on dialysis quantification and adequacy in the presence of a reduced treatment time [9].…”

Section: Hemodialysis Therapy: a Never-ending Journeymentioning

confidence: 99%

The Rise of Expanded Hemodialysis

Ronco

2017

Blood Purif

114

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The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molecule removal including β-2 microglobulin. Further advances in technology allowed better control over the structure and permeability of membranes. Different polymers and improved spinning modalities led to significant advances in solute removal and hemocompatibility. Inner surface modification produced a reduction in membrane thrombogenicity and protein-membrane interaction with a less tendency to fouling and permeability decay. Further evolution in technology led to the development of a new class of membranes referred to as protein-leaking membranes or super-flux or high cutoff (HCO). These membranes are more permeable than conventional HF membranes and allow some passage of proteins, including albumin. The rationale for these membranes is the need for increased clearance of low molecular weight proteins and protein-bound solutes. However, albumin loss in protein-leaking HCO membranes represents a limitation whose effect in patients is still controversial. The last evolution in the field of membranes is the development of a new class defined as “high retention onset” (HRO) due to the peculiar high sieving value in the middle to high molecular weight range. The introduction of HRO membranes in the clinical routine has enabled the development of a new concept therapy called “expanded hemodialysis.” Its simple set up and application offer the possibility to use it even in patients with suboptimal vascular access or even with an indwelling catheter. The system does not require particular hardware or unusual nursing skill. The quality of dialysis fluid is, however, mandatory to ensure a safe conduction of the dialysis session. This new therapy is likely to modify the outcome of end-stage kidney disease patients, thanks to the enhanced removal of molecules traditionally retained by current dialysis techniques.

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Section: Hemodialysis Therapy: a Never-ending Journeymentioning

confidence: 99%

The Rise of Expanded Hemodialysis

Ronco

2017

Blood Purif

114

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“…as well as vascular permeability factors. This explains why high Na concentration in the dialysate [11,12], or an isolated ultrafiltration [13], sigtension, as documented by many studies [5][6][7]. This data explains why in long treatments (?8 h) and slow-efficient nificantly reduce the incidence of symptomatic hypotension.…”

Section: Introductionmentioning

confidence: 95%

The Management of Hypotension in Dialyzed Patients

Zucchelli¹,

Santoro²

1999

Mineral Electrolyte Metab

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Acute hypotension is a frequent hemodialysis complication. This intra-treatment vascular instability is a multifactorial process in which procedure-related and patient-related factors may influence the decrease in plasma volume and the impairment of cardiovascular regulatory mechanisms. Identification of the most susceptible patients and of the various risk factors may contribute to significantly improving cardiovascular stability during dialysis. In some high-risk patients, continuous monitoring of the various parameters can predict the appearance of symptomatic hypotension and help to prevent its onset.

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“…Although cardiovascular intolerance during HD is mediated by multiple factors including inadequate plasma refilling, lack of appropriate vasoconstriction and deranged cardiac performance [12], recent data suggest that diminished plasma refilling constitutes the primary determinant of hemodynamic instability during extracorporeal circulation [8,13]. In the present study, we have demonstrated that the frequencies of hypotensive episodes and muscle cramps were reduced by a year of synthetic highflux HDF, compatible with the previous findings that high-flux HDF improved cardiovascular tolerance in the elderly [10].…”

Section: Discussionmentioning

confidence: 99%

Fitness of Biocompatible High-Flux Hemodiafiltration for Dialysis-Related Amyloidosis

Takenaka¹,

Itaya²,

Tsuchiya³

et al. 2000

Blood Purif

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Aims: In order to assess the long-term influence of high-flux hemodiafiltration (HDF) on hemodynamic stability in patients with dialysis-related amyloidosis. Methods: HDF with high-flux dialyzers was performed for a year in 11 patients who had undergone the surgery for carpal tunnel syndrome. Patients were divided into two groups, and for each group synthetic or cellulose membrane dialyzers were applied. Results: A year after the exchange from standard hemodialysis to HDF with cellulose high-flux dialyzers, β₂-microglobulin was decreased (45 ± 3 to 28 ± 2 mg/l, n = 5, p < 0.05), but plasma non-refilling ratio was not altered. However, the continuance of synthetic high-flux HDF for a year decreased plasma non-refilling ratio (17 ± 5 to 7 ± 4%, p < 0.05), hypotensive episodes (4.3 ± 0.6 to 2.5 ± 0.4 sessions/month, p < 0.05) and muscle cramps (3.8 ± 0.5 to 1.8 ± 0.5 sessions/month, p < 0.01) in addition to the decrements in serum β₂-microglobulin (45 ± 5 to 33 ± 2 mg/l, n = 6, p < 0.01). Conclusions: Although the study on a large number of patients may be required to draw a final conclusion, our present data suggest that biocompatible high-flux HDF is uniquely suited for dialysis-related amyloidosis.

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Technical and Clinical Evaluation of Different Short, Highly Efficient Dialysis Techniques

Cited by 44 publications

References 0 publications

The Rise of Expanded Hemodialysis

The Rise of Expanded Hemodialysis

The Management of Hypotension in Dialyzed Patients

Fitness of Biocompatible High-Flux Hemodiafiltration for Dialysis-Related Amyloidosis

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