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[On-line sequential hemodiafiltration (HDF-OL-S): a new therapeutic option]
J Kanter1, M Carretero Puerta, R Pérez García
1Servicio de Nefrología, Unidad de Hemodiálisis, Hospital G. U. Gregorio Marañón, Madrid, España. jkanter@senefro.org
Summary
On-line hemodiafiltration (OL-HDF) improves toxin clearance. A novel switching OL-HDF (OL-S-HDF) technique achieves similar ultrafiltration volumes as post-dilution OL-HDF (OL-P-HDF) in patients with poor vascular access.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Hemodialysis
Background:
- On-line hemodiafiltration (OL-HDF) offers superior clearance of uremic toxins.
- Achieving 20L ultrafiltration and 70% B2M reduction is challenging in patients with poor vascular access.
- This study evaluates a switching OL-HDF (OL-S-HDF) technique for improved ultrafiltration.
Purpose of the Study:
- To assess the efficiency of OL-S-HDF in achieving 20L ultrafiltration compared to OL-P-HDF.
- To compare toxin clearance and hemoconcentration parameters between OL-S-HDF, OL-P-HDF, and high-flux HD.
- To evaluate the correlation of pre-filter pressure (PFP) and transmembrane pressure (TMP) with patient outcomes.
Main Methods:
- 16 adult patients underwent three dialysis sessions: high-flux HD, OL-P-HDF, and OL-S-HDF.
- Clearance of urea, creatinine, B2M, and myoglobulin were compared.
- Pre-filter pressure (PFP) and transmembrane pressure (TMP) were measured.
Main Results:
- No significant differences in Kt/V, urea, or creatinine removal among the techniques.
- OL-HDF modes showed significantly higher B2M and myoglobulin clearance than HF-HD.
- OL-S-HDF demonstrated comparable efficacy to OL-P-HDF.
- PFP correlated better with albumin, hematocrit, and hemoconcentration than TMP.
Conclusions:
- OL-S-HDF is a viable alternative to OL-P-HDF for patients with suboptimal vascular access.
- This technique facilitates achieving target ultrafiltration volumes.
- PFP may provide more relevant clinical information than TMP.
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