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A Modified EPA Method 1623 that Uses Tangential Flow Hollow-fiber Ultrafiltration and Heat Dissociation Steps to Detect Waterborne Cryptosporidium and Giardia spp.

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Fluids in bags for hemodiafiltration.

Ingrid Ledebo¹

¹Gambro Research, Lund, Sweden.

Contributions to Nephrology

|August 9, 2007

Summary

Hemodiafiltration (HDF) enhances solute removal via convection. Classic HDF uses sterile replacement fluid bags, offering controlled convection but limited volume per session.

Area of Science:

Nephrology
Renal Replacement Therapy
Hemodialysis

Background:

Hemodiafiltration (HDF) aims to improve solute clearance beyond diffusion by utilizing convective transport.
Ultrafiltration (UF) exceeding weight loss targets is employed in HDF, requiring sterile replacement fluid to compensate.
Replacement fluid can be sourced from pre-packaged bags (classic HDF) or generated online (online HDF).

Purpose of the Study:

To evaluate the efficacy and limitations of classic hemodiafiltration (HDF) using pre-packaged replacement fluid solutions.
To compare the convective transport achieved in classic HDF with other dialysis modalities.
To highlight the practical considerations and benefits of controlled convection in HDF.

Main Methods:

Review of clinical studies comparing convective transport in different HDF methods and high-flux dialysis.

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Analysis of the composition requirements for HDF replacement solutions (sterile, nonpyrogenic, plasma water mimic).

Assessment of practical handling limitations associated with bagged replacement fluids in classic HDF.

Main Results:

Classic HDF allows for controlled convective doses and fluid quality.
The convective transport in classic HDF is comparable to contemporary high-flux dialysis with uncontrolled ultrafiltration and backfiltration.
Practical handling of bagged solutions limits convection to approximately 10-12 liters per session in classic HDF.

Conclusions:

Classic HDF provides a method for delivering HDF with controlled fluid quality and convection.
While effective, the volume of convection in classic HDF is constrained by the practicalities of using bagged replacement fluids.
Further advancements may be needed to overcome the volume limitations of classic HDF while maintaining fluid quality.