Journal articles: 'High volume haemodiafiltration'

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Mitra, Sandip. "High-volume online haemodiafiltration: the gold standard in thrice-weekly dialysis." Journal of Renal Nursing 5, no. 3 (May 2013): 142–47. http://dx.doi.org/10.12968/jorn.2013.5.3.142.

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Mostovaya, Ira M., Muriel P. C. Grooteman, Carlo Basile, Andrew Davenport, Camiel L. M. de Roij van Zuijdewijn, Christoph Wanner, Menso J. Nubé, and Peter J. Blankestijn. "High convection volume in online post-dilution haemodiafiltration: relevance, safety and costs." Clinical Kidney Journal 8, no. 4 (June 7, 2015): 368–73. http://dx.doi.org/10.1093/ckj/sfv040.

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Aires, I., P. Matias, C. Gil, C. Jorge, and A. Ferreira. "On-line haemodiafiltration with high volume substitution fluid: long-term efficacy and security." Nephrology Dialysis Transplantation 22, no. 1 (October 18, 2006): 286–87. http://dx.doi.org/10.1093/ndt/gfl381.

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Tamme, Kadri, Liivi Maddison, Rein Kruusat, Hans-Erik Ehrlich, Mirjam Viirelaid, Hartmut Kern, and Joel Starkopf. "Effects of High Volume Haemodiafiltration on Inflammatory Response Profile and Microcirculation in Patients with Septic Shock." BioMed Research International 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/125615.

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Background. High volumes of haemofiltration are used in septic patients to control systemic inflammation and improve patient outcomes. We aimed to clarify if extended intermittent high volume online haemodiafiltration (HVHDF) influences patient haemodynamics and cytokines profile and/or has effect upon sublingual microcirculation in critically ill septic shock patients.Methods. Main haemodynamic and clinical variables and concentrations of cytokines were evaluated before and after HVHDF in 19 patients with septic shock requiring renal replacement therapy due to acute kidney injury. Sublingual microcirculation was assessed in 9 patients.Results. The mean (SD) time of HVHDF was 9.4 (1.8) hours. The median convective volume was 123 mL/kg/h. The mean (SD) dose of norepinephrine required to maintain mean arterial pressure at the target range of 70–80 mmHg decreased from 0.40 (0.43) μg/kg/min to 0.28 (0.33) μg/kg/min (p= 0.009). No significant changes in the measured cytokines or microcirculatory parameters were observed before and after HVHDF.Conclusions. The single-centre study suggests that extended HVHDF results in decrease of norepinephrine requirement in patients with septic shock. Haemodynamic improvement was not associated with decrease in circulating cytokine levels, and sublingual microcirculation was well preserved.

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Tamme, K., K. Oselin, K. Kipper, T. Tasa, T. Metsvaht, J. Karjagin, K. Herodes, H. Kern, and J. Starkopf. "Pharmacokinetics and pharmacodynamics of piperacillin/tazobactam during high volume haemodiafiltration in patients with septic shock." Acta Anaesthesiologica Scandinavica 60, no. 2 (September 10, 2015): 230–40. http://dx.doi.org/10.1111/aas.12629.

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Bourquin, Vincent, Belén Ponte, Jérôme Pugin, Pierre-Yves Martin, and Patrick Saudan. "Use of high-volume haemodiafiltration in patients with refractory septic shock and acute kidney injury." Clinical Kidney Journal 6, no. 1 (December 9, 2012): 40–44. http://dx.doi.org/10.1093/ckj/sfs166.

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Chazot, Charles, Sebastien Deleuze, Baya Fadel, Hadia Hebibi, Guillaume Jean, Martial Levannier, Olivier Puyoo, David Attaf, Stefano Stuard, and Bernard Canaud. "Is high-volume post-dilution haemodiafiltration associated with risk of fluid volume imbalance? A national multicentre cross-sectional cohort study." Nephrology Dialysis Transplantation 34, no. 12 (August 29, 2019): 2089–95. http://dx.doi.org/10.1093/ndt/gfz141.

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Abstract Background Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers. Method This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®. Results 2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Comparing the HD and OL-HDF groups, there was no difference between HD and OL-HDF patients regarding the predialysis systolic BP, the interdialytic weight gain, the dialysate-plasma sodium gradient, and the predialysis RelFO%. The stepwise logistic regression did not find dialysis modality (HD or OL-HDF) associated with fluid overload or high predialysis systolic blood pressure. In OL-HDF patients, monthly average convective or weekly infusion volumes per session were not related with the presence of fluid overload. Conclusions In this cross-sectional study we did not find association between the use of post-dilution OL-HDF and markers of fluid volume excess. Aligned dialysis fluid sodium concentrations to patient predialysis plasma sodium and regular monitoring of fluid volume status by bioimpedance spectroscopy may have been helpful to manage adequately the fluid status in both OL-HDF and HD patients.

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Schiffl, Helmut. "High-volume online haemodiafiltration treatment and outcome of end-stage renal disease patients: more than one mode." International Urology and Nephrology 52, no. 8 (June 2, 2020): 1501–6. http://dx.doi.org/10.1007/s11255-020-02489-9.

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Panichi, Vincenzo, Enrico Fiaccadori, Alberto Rosati, Roberto Fanelli, Giada Bernabini, Alessia Scatena, and Francesco Pizzarelli. "Post-Dilution on Line Haemodiafiltration with Citrate Dialysate: First Clinical Experience in Chronic Dialysis Patients." Scientific World Journal 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/703612.

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Background. Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF).Methods. Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions) of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate.Results. In citrate OL-HDF pretreatment plasma levels of C-reactive protein andβ2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range.Conclusions.Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.

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Kron, J., S. Kron, R. Wenkel, H. U. Schuhmacher, U. Thieme, T. Leimbach, H. Kern, H. H. Neumayer, and T. Slowinski. "Extended daily on-line high-volume haemodiafiltration in septic multiple organ failure: a well-tolerated and feasible procedure." Nephrology Dialysis Transplantation 27, no. 1 (May 28, 2011): 146–52. http://dx.doi.org/10.1093/ndt/gfr269.

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Molina, Pablo, Belén Vizcaíno, Mariola D. Molina, Sandra Beltrán, Mercedes González-Moya, Antonio Mora, Cristina Castro-Alonso, et al. "The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study." Nephrology Dialysis Transplantation 33, no. 7 (January 22, 2018): 1223–35. http://dx.doi.org/10.1093/ndt/gfx342.

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Canaud, Bernard, Inga Bayh, Daniele Marcelli, Pedro Ponce, Jos� Ignacio Merello, Konstantin Gurevich, Erzsebet Ladanyi, et al. "Improved Survival of Incident Patients with High-Volume Haemodiafiltration: A Propensity-Matched Cohort Study with Inverse Probability of Censoring Weighting." Nephron 129, no. 3 (February 27, 2015): 179–88. http://dx.doi.org/10.1159/000371446.

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Bolasco, Piergiorgio, Pierluigi Spiga, Marcella Arras, Stefano Murtas, and Giorgio La Nasa. "Could there be Haemodynamic Stress Effects on Pro-Inflammatory CD14+CD16+ Monocytes during Convective-Diffusive Treatments? A Prospective Randomized Controlled Trial." Blood Purification 47, no. 4 (2019): 385–94. http://dx.doi.org/10.1159/000494711.

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Background: The main aim is to compare the pro-inflammatory CD14+CD16+ monocytes blood levels in patient in end-stage renal disease (ESRD) undergoing Mixed online Haemodiafiltration (Mixed OL-HDF) vs. post-dilution OL-HDF and online high-efficiency haemodialysis. Methods: The study is a prospective double-blind randomized controlled cross-over trial. Dialysis monitor, membrane, duration and dialytic adequacy, volume ultrapure dialysate/infusion were the same in all treatments. Monocyte CD14+CD16+, CD14-CD16+, IL-2R, TNFα, IL-1β, IL-8, IL-6, IL-10, β2-microglobulin outcome were measured. Results: Mixed OL-HDF showed a less expression on the activated monocytes CD14+CD16+, CD14-CD16+ (–15.5%). There was no difference between cytokines and high sensitivity C-reactive protein and in other haemato-chemical inflammatory parameters except a significative decrease of TNF-α during Mixed OL-HDF. Conclusion: We found that Mixed OL-HDF could inhibit the CD14+CD16+ peripheral blood lymphocytes related to a less hemorheology stress inside capillary dialysis filter but in this study there is not still ascertainable its superiority compared to post OL-HDF and post OL-HEH.

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Panichi, V., A. Scatena, A. Rosati, R. Giusti, G. Ferro, E. Malagnino, A. Capitanini, et al. "High-volume online haemodiafiltration improves erythropoiesis-stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study." Nephrology Dialysis Transplantation 30, no. 4 (November 10, 2014): 682–89. http://dx.doi.org/10.1093/ndt/gfu345.

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Crucelegui, Soledad, Rosario Luxardo, Romina Philipi, Maria Luisa Coli, Estefanía Espejo, Erika Pucca, Anahí Quintero, et al. "Successful pregnancy in a patient with high volume pre-dilution on-line haemodiafiltration. Is it the best dialysis option in women with chronic kidney disease?" Nefrología (English Edition) 40, no. 6 (November 2020): 683–84. http://dx.doi.org/10.1016/j.nefroe.2019.11.008.

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Locatelli, Francesco, Leano Violo, Selena Longhi, and Lucia Del Vecchio. "Current Evidence in Haemodiafiltration." Blood Purification 40, Suppl. 1 (2015): 24–29. http://dx.doi.org/10.1159/000437410.

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Background: Standard low-flux haemodialysis (HD) is not very efficacious, and patient morbidity and mortality rates are still very high. According to the initial study design, the MPO study reported that high-flux HD (hf-HD) showed a significant 37% relative risk reduction of mortality in patients with serum albumin ≤4 g/dl; online haemodiafiltration (HDF) is considered the most efficient technique of using high-flux membranes, as clearances of small solutes, like urea, are higher than in haemofiltration and clearances of middle solutes, like β2-microglobulin, are higher than in hf-HD. Summary: Three randomized trials have recently been published analysing the effect of online HDF on mortality. Two trials were unable to demonstrate a positive effect of HDF on survival, while 1 showed a significantly better survival in patients randomized to HDF in comparison to those randomized to hf-HD. It is intriguing that post hoc analyses of these 3 studies showed that the patients randomized to online HDF who received the highest convection volumes had a lower risk of mortality and cardiovascular events than those randomized to HD. Four very recently published meta-analyses have shown inconsistent results concerning the effect of convective treatments in improving patient general and cardiovascular survival, while they have consistently shown a significant reduction of the intradialytic symptomatic hypotension in patients treated with convective techniques in comparison with those treated with prevalent diffusive ones. Key Messages: The results of the randomized trials on the effect of HDF in improving patient survival are inconclusive. Moreover, trials specifically designed for testing the effect of increased convection of online HDF on patient survival and morbidity in comparison to patients treated with hf-HD are still awaited.

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Potier, Jacky, Thibault Dolley-Hitze, Didier Hamel, Isabelle Landru, Erick Cardineau, Guillaume Queffeulou, Elie Zagdoun, et al. "Long-term effects of citric acid-based bicarbonate haemodialysis on patient outcomes: a survival propensity score–matched study in western France." Nephrology Dialysis Transplantation 35, no. 7 (January 18, 2020): 1228–36. http://dx.doi.org/10.1093/ndt/gfz274.

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Abstract Background Citric acid–based bicarbonate haemodialysis (CIT-HD) has gained more clinical acceptance over the last few years in France and is a substitute for other acidifiers [e.g. acetic acid (CH3COOH) and hydrochloric acid (HCl)]. This trend was justified by several clinical benefits compared with CH3COOH as well as the desire to avoid the consequences of the corrosive action of HCl, but a nationwide clinical report raised concerns about the long-term safety of CIT-HD. The aim of this study was to assess the long-term effects of CIT-HD exposure on patient outcomes in western France. Methods This is a population-based retrospective multicentre observational study performed in 1132 incident end-stage kidney disease patients in five sanitary territories in western France who started their renal replacement therapy after 1 January 2008 and followed up through 15 October 2018. Relevant data, collected prospectively with the same medical software, were anonymously aggregated for the purposes of the study. The primary goal of this study was to investigate the effects of citrate exposure on all-cause mortality. To provide a control group to CIT-HD one, propensity score matching (PSM) at 2:1 was performed in two steps: the first analysis was intended to be exploratory, comparing patients who received citrate ≤80% of the time (CIT-HD ≤80) versus those who received citrate >80% of the time (CIT-HD >80), while the second analysis was intended to be explanatory in comparing patients with 0% (CIT-HD0) versus 100% citrate time exposure (CIT-HD100). Results After PSM, in the exploratory part of the analysis, 432 CIT-HD ≤80 patients were compared with 216 CIT-HD >80 patients and no difference was found for all-cause mortality using the Kaplan–Meier model (log-rank 0.97), univariate Cox regression analysis {hazard ratio [HR] 1.01 [95% confidence interval (CI) 0.71–1.40]} and multivariate Cox regression analysis [HR 1.11 (95% CI 0.76–1.61)] when adjusted for nine variables with clinical pertinence and high statistical relevance in the univariate analysis. In the explanatory part of the analysis, 316 CIT-HD0 patients were then compared with 158 CIT-HD100 patients and no difference was found using the Kaplan–Meier model (log-rank 0.06), univariate Cox regression analysis [HR 0.69 (95% CI 0.47–1.03)] and multivariate Cox regression analysis [HR 0.87 (95% CI 0.57–1.33)] when adjusted for seven variables with clinical pertinence and high statistical relevance in the univariate analysis. Conclusions Findings of this study support the notion that CIT-HD exposure ≤6 years has no significant effect on all-cause mortality in HD patients. This finding remains true for patients receiving high-volume online haemodiafiltration, a modality most frequently prescribed in this cohort.

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Macías, Nicolás, Soraya Abad, Almudena Vega, Santiago Cedeño, Alba Santos, Úrsula Verdalles, Tania Linares, et al. "High convective volumes are associated with improvement in metabolic profile in diabetic patients on online haemodiafiltration." Nefrología (English Edition) 39, no. 2 (March 2019): 168–76. http://dx.doi.org/10.1016/j.nefroe.2018.08.004.

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Veron, Delma. "Comments on "High convective volumes are associated with improvement in metabolic profile in diabetic patients on online haemodiafiltration"." Nefrología (English Edition) 40, no. 1 (January 2020): 111–12. http://dx.doi.org/10.1016/j.nefroe.2019.06.004.

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Ficheux, Alain, Nathalie Gayrard, Ilan Szwarc, Flore Duranton, Fernando Vetromile, Philippe Brunet, Marie-Françoise Servel, Joachim Jankowski, and Àngel Argilés. "Measuring intradialyser transmembrane and hydrostatic pressures: pitfalls and relevance in haemodialysis and haemodiafiltration." Clinical Kidney Journal 13, no. 4 (April 19, 2019): 580–86. http://dx.doi.org/10.1093/ckj/sfz033.

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Abstract Background Post-dilutional haemodiafiltration (HDF) with high convection volumes (HCVs) could improve survival. HCV-HDF requires a significant pressure to be applied to the dialyser membrane. The aim of this study was to assess the pressure applied to the dialysers in HCV-HDF, evaluate the influence of transmembrane pressure (TMP) calculation methods on TMP values and check how they relate to the safety limits proposed by guidelines. Methods Nine stable dialysis patients were treated with post-dilutional HCV-HDF with three different convection volumes [including haemodialysis (HD)]. The pressures at blood inlet (Bi), blood outlet (Bo) and dialysate outlet (Do) were continuously recorded. TMP was calculated using two pressures (TMP2: Bo, Do) or three pressures (TMP3: Bo, Do, Bi). Dialysis parameters were analysed at the start of the session and at the end of treatment or at the first occurrence of a manual intervention to decrease convection due to TMP alarms. Results During HD sessions, TMP2 and TMP3 remained stable. During HCV-HDF, TMP2 remained stable while TMP3 clearly increased. For the same condition, TMP3 could be 3-fold greater than TMP2. This shows that the TMP limit of 300 mmHg as recommended by guidelines could have different effects according to the TMP calculation method. In HCV-HDF, the pressure at the Bi increased over time and exceeded the safety limits of 600 mmHg provided by the manufacturer, even when respecting TMP safety limits. Conclusions This study draws our attention to the dangers of using a two-pressure points TMP calculation, particularly when performing HCV-HDF.

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Cavalli, Andrea, and Giuseppe Pontoriero. "Emodiafiltrazione e sopravvivenza: cosa abbiamo imparato dai più recenti studi clinici controllati?" Giornale di Clinica Nefrologica e Dialisi 25, no. 1 (August 3, 2013): 72–76. http://dx.doi.org/10.33393/gcnd.2013.1009.

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Oggigiorno, è opinione comune che, rispetto all'emodialisi standard (HD), l'emodiafiltrazione on-line (HDF) possa consentire migliori risultati in termini di tolleranza intradialitica, stato nutrizionale, mantenimento della funzione renale residua, responsività all'eritropoietina e controllo della fosforemia. Tuttavia, finora, gli studi controllati non sono stati in grado di dimostrare la superiorità dell'HDF nel ridurre la morbilità e la mortalità. Due recenti studi prospettici, randomizzati e controllati, il “Convective Transport Study” (CONTRAST) e il “Comparison of Post-dilution Online Haemodiafiltration and Haemodialysis” (TURKISH OL-HDF STUDY), hanno confrontato la sopravvivenza e gli eventi cardiovascolari in HDF e in HD. Benché fossero studi ampi e appositamente disegnati per valutare questo importante outcome, non è stato possibile trovare differenze significative tra i due trattamenti (HDF vs HD low-flux nel CONTRAST e HDF vs HD high-flux nel TURKISH STUDY). In analisi post-hoc, entrambi gli studi hanno mostrato come alti volumi convettivi fossero associati a una migliore prognosi, anche se questi risultati devono essere considerati solo “generatori di ipotesi” e necessitano di essere testati in adeguati trial. I risultati derivanti dallo studio spagnolo e francese, non ancora pubblicati, ci aiuteranno a comprendere meglio l'importanza dell'HDF nella pratica clinica quotidiana.

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"Comparative Clinical Performance of Dialyzers Applied During High Volume Online Haemodiafiltration." Case Medical Research, September 25, 2019. http://dx.doi.org/10.31525/ct1-nct04102280.

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Vernooij, Robin, Mei-Man Lee, Mark Woodward, Jörgen Hegbrant, Bernard Canaud, Krister Cromm, Marietta Torok, et al. "MO812THE COMPARISON OF HIGH-DOSE HAEMODIAFILTRATION WITH HIGH-FLUX HAEMODIALYSIS (CONVINCE) STUDY: BASELINE CHARACTERISTICS AND PROOF OF PRINCIPLE OF THE CONVECTION VOLUME DELIVERED." Nephrology Dialysis Transplantation 36, Supplement_1 (May 1, 2021). http://dx.doi.org/10.1093/ndt/gfab098.004.

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Abstract Background and Aims Although high-dose haemodiafiltration (HDF) has shown some promising survival advantage compared with high-flux haemodialysis (HD), the evidence remains controversial. In view of these discrepant results, a definitive trial is required to determine whether high-dose HDF is superior to high-flux HD. The comparison of high-dose HDF with high-flux HD (CONVINCE) study will assess the benefits and harms of high-dose HDF versus conventional high-flux HD in adults with end-stage kidney disease (ESKD). Here we provide information on the baseline characteristics of the included patients and evaluate whether the patients randomised to HDF were able to reach a high-dose convection volume. Method This international, prospective, open label, randomised, controlled trial is aiming to recruit 1800 ESKD adults treated with high-flux HD in 9 European countries. Patients will be randomised 1:1 to high-dose HDF versus continuation of conventional high-flux HD. High-dose HDF is defined as a convection volume per session of ≥23 L (range ±1 L). The trial is designed with a follow-up time for each patient of at least 24 months and will assess all-cause mortality, cause-specific mortality, cardiovascular events, hospitalisation, patient-reported outcomes, and cost-effectiveness. For this study we tabulated the baseline characteristics for all randomised participants by treatment groups. For the patients randomised to HDF, we calculated the proportion of the patients reaching a convection volume of ≥ 23L. session on the first visit after baseline (i.e. 3 months) and compared baseline and treatment characteristics with the patients with a convection volume of <23L/session. Results CONVINCE has recruited, until the start of January 2021, 1139 patients in eight European countries. The mean age was 62.4 (SD: 13.2) years and 62% (n=709) patients were men. The mean dialysis vintage was 5.0 (6.1) years. The mean systolic blood pressure (BP) was 141 (22) mmHg, the diastolic BP was 73 (14) mmHg, and the body mass index (BMI) was 27.6 (5.7) kg/m2. Approximately one-third the patients had diabetes mellitus and 21% had a history of coronary heart disease at baseline. Of the patients randomised to HDF, over 85% achieved a convection volume of ≥23L/session. There were no apparent differences in baseline and treatment characteristics between the patients who reached a convective volume of ≥23L/session versus those who did not: the vascular access was, respectively, a fistula (82% vs 81%), catheter (13% vs 14%), and graft (5% vs 5%) access. Conclusion The CONVINCE study will run up to 2023 and addresses the question of benefits and harms, regarding survival, hospitalisation, patient-reported outcomes, and cost-effectiveness of high-dose HDF compared with high-flux HD in patients with ESKD. This first analysis shows that achievement of high-dose HDF is feasible for most patients and, most importantly, could be maintained during the present trial period.

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Béguin, Lisa, Thierry Krummel, Nathalie Longlune, Roula Galland, Cécile Couchoud, and Thierry Hannedouche. "Dialysis dose and mortality in haemodialysis: is higher better?" Nephrology Dialysis Transplantation, June 17, 2021. http://dx.doi.org/10.1093/ndt/gfab202.

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Abstract Background The effect of dialysis dose on mortality remains unsettled. Current guidelines recommend targeting a single-pool Kt/V (spKt/V) at 1.20–1.40 per thrice-weekly dialysis session. However, the optimal dialysis dose remains mostly disputed. Methods In a nationwide registry of all incident patients receiving thrice-weekly haemodialysis, 32 283 patients had available data on dialysis dose, estimated by Kt/V and its variants epuration volume per session (Kt) and Kt indexed to body surface area (Kt/A). Survival was analysed with a multivariate Cox model and a concurrent risk model accounting for renal transplantation. A predictive model of Kt in the upper quartile was developed. Results Regardless of the indicator, a higher dose of dialysis was consistently associated with better survival. The survival differential of Kt was the most discriminating, but marginally, compared with the survival differential according to Kt/V and Kt/A. Patient survival was higher in the upper quartile of Kt (>69 L/session) then deteriorated as the Kt decreased, with a difference in survival between the upper and lower quartile of 23.6% at 5 years. Survival differences across Kt distribution were similar after accounting for kidney transplantation as a competing risk. Predictive factors for Kt in the upper quartile were arteriovenous fistula versus catheters and graft, haemodiafiltration versus haemodialysis, scheduled dialysis start versus emergency start, long weekly dialysis duration and spKt/V measurement versus double-pool equilibrated Kt/V. Conclusions Our data confirm the existence of a relationship between dialysis dose and survival that persisted despite correcting for known confounders. A model for predicting a high dose of dialysis is proposed with practical relevance.

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Vandenbosch, Ines, Sander Dejongh, Kathleen Claes, Bert Bammens, Katrien De Vusser, Amaryllis Van Craenenbroeck, Dirk Kuypers, Pieter Evenepoel, and Björn Meijers. "Strategies for asymmetrical triacetate dialyser heparin-free effective haemodialysis: the SAFE study." Clinical Kidney Journal, November 28, 2020. http://dx.doi.org/10.1093/ckj/sfaa228.

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Abstract Background In haemodialysis, maintaining patency of the extracorporeal circuit requires the use of anticoagulants. Although (low molecular weight) heparins are the mainstay, these are not well tolerated in all patients. Alternative approaches include saline infusion, citrate-containing dialysate, regional citrate anticoagulation or the use of heparin-coated membranes. Asymmetric cellulose triacetate (ATA) dialysers have a low degree of platelet contact activation and might be an alternative to heparin-coated dialysers. The aim of this study was to test the clotting propensity of ATA when used without systemic anticoagulation. Methods We performed a Phase II pilot study in maintenance dialysis patients. The ‘Strategies for Asymmetrical Triacetate dialyzer heparin-Free Effective hemodialysis’ (SAFE) study was a two-arm open-label crossover study. In Arm A, patients were dialysed using 1.9 m2 ATA membranes in combination with a citrate-containing dialysate (1 mM). In Arm B, the ATA membrane was combined with high-volume predilution haemodiafiltration (HDF) without any other anticoagulation. The primary endpoint was the success rate to complete 4 h of haemodialysis without preterm clotting. Secondary endpoints included time to clotting and measures of dialysis adequacy. Results We scheduled 240 dialysis sessions (120/arm) in 20 patients. Patients were randomized 1:1 to start with Arm A or B. All patients crossed to the other arm halfway through the study. A total of 232 (96.7%) study treatments were delivered. Overall, 23 clotting events occurred, 7 in Arm A and 16 in Arm B. The success rate in Arm A (ATA + citrate-containing dialysate) was 90.8/94.0% [intention to treat (ITT)/as treated]. The success rate in Arm B (ATA + predilution HDF) was 83.3/86.2% (ITT/as treated). Time to clotting was borderline significantly better in Arm A (Mantel-Cox log rank P = 0.05). Conclusion ATA dialysers have a low clotting propensity and both predilution HDF and a citrate-containing dialysate resulted in high rates of completed dialysis sessions.

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Sargsyan, Mari, Juan Robles, Sheila Cabello Pelegrin, Juana Maria Ferrer Balaguer, Juan Rey Valeriano, Sonia Cleofe Jimenez Mendoza, Cristina Egea Sancho, et al. "P1533SURVIVAL ANALYSIS OH HAEMODIALYSIS PATIENTS: IMPACTO OF UREMIC TOXINS." Nephrology Dialysis Transplantation 35, Supplement_3 (June 1, 2020). http://dx.doi.org/10.1093/ndt/gfaa142.p1533.

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Abstract Background and Aims HEMO study showed that β2M level over time was predictive of all-cause mortality in haemodialysis patients (HD). Later studies suggested that protein-bound uremic toxins are associated with mortality in HD patients but with recent contrasting results. Aim of study was to analyse β2M and indoxyl sulfate (IS) as predictor factors of mortality. Method 5 years follow-up of 60 prevalent HD patients of our hospital. Demographic data was described. Baseline midweek pre-dialysis serum β2M was determined by nephelometry and total IS levels by high performance liquid chromatograph connected to a UV detector. We considered high serum β2M group as if was equal or higher than 27,5 mg/L. As to IS, patients were divided into quartiles (1q <9,7 mg/L, 2-3q ≥9.7-26.5mg/L, 4q>26.5 mg/L). Survival curves were assessed using the Kaplan–Meier analysis at 1,2,3 and 5 years in univariate analysis for albumin (≥38 g/L or lower), β2M, and total IS groups, and evaluated by the proportional hazards Cox´s model. P -values <0.05 were considered statistically significant. Results 60 prevalent patients with mean vintage of 46,8 months (range 3-299 months). Mean age was 60±20 years. Males were more prevalent (53,3% vs 46,6%). 35% had diabetes. 51,6% underwent conventional hemodialysis (HD), 48,3% post-dilution haemodiafiltration, with mean convective volume of 23,8±2,8L. Mean eKt/V was 1,67±0,4, mean nPCR was 1±0,27g/kg/day. Only 8,3% of patients had urine volume>500cc/24hours. Mean β2M level was 35,6±1,9mg/L (X±SE) and mean total IS level was 18,9±1,6mg/L. The overall mortality at 5 years was 57%. Albuminemia lower than 38g/L was associated with mortality at 2, 3, and 5-years in univariate analysis (Cox´s F test p=0.03, figure 1). We found no difference in survival rate between patients with high or low serum β2M levels at 3- or 5-years analysis (Cox´s F test p=0.27). At 2 years analysis, patients in the lower β2M group had better survival (Cox´s F test p=0.04, Figure 1). There was no statistically significant association between albumin, β2M, IS level and all-cause mortality on Cox regression multivariate analysis. We observe no statistically significant association between IS levels and all-cause mortality neither on univariate, nor on multivariate analysis. Conclusion β2M < 27,5 mg/l was associated with better survival at 2 years univariate analysis. IS had no statistically significant association with all-cause mortality in our cohort.

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Kim, Tae Hoon, Seok-hyung Kim, Tae Yeon Kim, Hae Yeul Park, Kwon Soo Jung, Moon Hyoung Lee, Jong Hyun Jhee, Jung Eun Lee, Hoon Young Choi, and Hyeong Cheon Park. "Removal of large middle molecules via haemodialysis with medium cut-off membranes at lower blood flow rates: an observational prospective study." BMC Nephrology 21, no. 1 (December 31, 2019). http://dx.doi.org/10.1186/s12882-019-1669-3.

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Abstract Background Online haemodiafiltration (OL-HDF) may improve middle molecular clearance in contrast to conventional haemodialysis (HD). However, OL-HDF requires higher convective flows and cannot sufficiently remove large middle molecules. This study evaluated the efficacy of a medium cut-off (MCO) dialyser in removing large middle molecular uraemic toxins and compared it with that of conventional high-flux (HF) dialysers in HD and predilution OL-HDF. Methods Six clinically stable HD patients without residual renal function were investigated. Dialyser and treatment efficacies were examined during a single midweek treatment in three consecutive periods: 1) conventional HD using an HF dialyser, 2) OL-HDF using the same HF dialyser, and 3) conventional HD using an MCO dialyser. Treatment efficacy was assessed by calculating the reduction ratio (RR) for β2-microglobulin (β2M), myoglobin, κ and λ free light chains (FLCs), and fibroblast growth factor (FGF)-23 and measuring clearance for FLCs. Results All three treatments showed comparable RRs for urea, phosphate, creatinine, and uric acid. MCO HD showed greater RRs for myoglobin and λFLC than did HF HD and predilution OL-HDF (myoglobin: 63.1 ± 5.3% vs. 43.5 ± 8.9% and 49.8 ± 7.3%; λFLC: 43.2 ± 5.6% vs. 26.8 ± 4.4% and 33.0 ± 9.2%, respectively; P < 0.001). Conversely, predilution OL-HDF showed the greatest RR for β2M, whereas MCO HD and HF HD showed comparable RRs for β2M (predilution OL-HDF vs. MCO HD: 80.1 ± 4.9% vs. 72.6 ± 3.8%, P = 0.01). There was no significant difference among MCO HD, HF HD, and predilution OL-HDF in the RRs for κFLC (63.2 ± 6.0%, 53.6 ± 15.5%, and 61.5 ± 7.0%, respectively; P = 0.37), and FGF-23 (55.5 ± 20.3%, 34.6 ± 13.1%, and 35.8 ± 23.2%, respectively; P = 0.13). Notably, MCO HD showed improved clearances for FLCs when compared to HF HD or OL-HDF. Conclusions MCO HD showed significantly greater RR of large middle molecules and achieved improved clearance for FLCs than conventional HD and OL-HDF, without the need for large convection volumes or high blood flow rates. This would pose as an advantage for elderly HD patients with poor vascular access and HD patients without access to OL-HDF. Trial registration Clinical Research Information Service (CRIS): KCT 0003009. The trial was prospectively registered on the 21 Jul 2018.

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Journal articles on the topic 'High volume haemodiafiltration'

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