Clinical and technical aspects of hemofiltration

Area of Science:

• Nephrology
• Biomedical Engineering

Background:

• Chronic renal insufficiency necessitates effective waste removal.
• Hemofiltration utilizes convective transport across high-porosity membranes for uremic substance removal, differing from hemodialysis.
• Previous studies established hemofiltration as a treatment option since 1974.

Purpose of the Study:

• To compare the efficacy and safety of hemofiltration versus hemodialysis in patients with chronic renal insufficiency.
• To evaluate the impact of hemofiltration on blood pressure and circulatory stability.
• To explore advancements in artificial kidney technology, including fluid regeneration systems.

Main Methods:

• A controlled study initiated in January 1978 compared hemofiltration and hemodialysis.
• Patients with chronic renal insufficiency received regular hemofiltration three times weekly for 4-5 hours.
• A fluid regeneration system involving a charcoal cartridge and bioelectric cell was investigated.

Main Results:

• Hemofiltration demonstrated normalization of blood pressure in hypertensive patients.
• Remarkable circulatory stability was observed, even in hypotensive patients with fluid overload.
• Hemofiltration exhibited a lower frequency of hypotensive episodes compared to hemodialysis, especially in older patients.

Conclusions:

• Hemofiltration is a viable and often preferred treatment for chronic renal insufficiency, particularly for elderly patients with cardiovascular or cerebrovascular conditions.
• The technique offers improved hemodynamic stability over traditional hemodialysis.
• Miniaturization of the artificial kidney remains a challenge due to the need for precise fluid proportioning systems, though fluid regeneration shows promise.