Technical and clinical data on high-performance hemofiltration: twelve patients during one year

Area of Science:

• Nephrology
• Renal Replacement Therapy

Background:

• Chronic hemodialysis (HD) patients often experience uremia and vascular instability.
• Conventional HD sessions are lengthy and may have suboptimal patient tolerance.

Purpose of the Study:

• To evaluate postdilutional hemofiltration (HF) as an alternative to conventional acetate hemodialysis (HD).
• To achieve no increase in pre-treatment uremia, shorter HF duration, and identical disposable costs compared to HD.
• To assess clinical tolerance and vascular stability with HF.

Main Methods:

• 12 chronic hemodialysis patients underwent postdilutional HF, substituting for conventional HD.
• Key parameters monitored included ultrafiltrate volume, ultrafiltrate rate, session duration, uremia levels, and clinical tolerance.
• Hemofilter reuse and extemporaneous preparation of substitution fluid were employed.

Main Results:

• HF achieved no significant increase in pre-treatment uremia (35.4 mmol/L vs 34.0 mmol/L).
• HF session duration was reduced (mean 190 min vs 250 min) with an ultrafiltrate rate of 143 ml/min.
• HF demonstrated better clinical tolerance and vascular stability, with identical disposable costs and no pyrogen reactions.

Conclusions:

• High-flux HF provides equivalent small molecule removal to conventional HD, with enhanced vascular stability and reduced session duration.
• Routine high-flux HF is a workable treatment modality in dialysis units.
• Vascular access is the primary limiting factor for widespread adoption of high-flux HF, currently suitable for 30-40% of patients.