A simple efficient technique of 'mid-dilution' on-line hemodiafiltration
Paweena Susantitaphong1, Khajohn Tiranathanagul, Orrawadee Hanvivatvong
1Extracorporeal Multiorgan Support Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Background:
On-line hemodiafiltration (OL-HDF) with pre- as well as post-dilution reinfusion mode provides superior uremic toxin removal, especially middle uremic toxins, and can improve patient survival. Both standard pre- and post-dilution have limitations. Mid-dilution OL-HDF (Nephros OLpur) was invented to overcome the disadvantages of both standard modes, but such a cartridge is only available in limited centers and is expensive.
Methods:
We created a simple technique of mid-dilution OL-HDF that can be easily set up in every hemodialysis center. Twelve stable end-stage renal disease patients were dialyzed in a random sequence with three different infusion modes of OL-HDF (simple mid-dilution, standard pre-dilution and post-dilution). Small molecule, middle molecule, and protein-bound uremic toxin clearances were measured.
Results:
Simple mid-dilution OL-HDF provided high efficiency in uremic toxin clearances with less protein loss.
Conclusion:
Simple mid-dilution OL-HDF combines the advantages of pre- and post-dilution modes without adverse effects. Thus, this technique could be useful in decreasing morbidity and mortality in hemodialysis patients.
Related Concept Videos
Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
Dialysis
Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Hemodialysis II: Procedure and Complications
Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
Hemodialysis I: Introduction

