Predilution hemofiltration: a new technology applied to an old therapy

Area of Science:

• Nephrology
• Renal Replacement Therapy

Background:

• Postdilution hemofiltration (HF) practiced in the 1980s faced medical, practical, and economic challenges.
• High blood flow rates, hematocrit, and body weight extended treatment times and increased costs.
• Limited clearance and difficulty using bicarbonate made HF an expensive therapy.

Purpose of the Study:

• To address the limitations of postdilution hemofiltration.
• To introduce predilution hemofiltration using on-line prepared solutions.
• To evaluate the efficacy and economic viability of predilution HF.

Main Methods:

• Implementing hemofiltration in a predilution mode.
• Utilizing on-line prepared infusion solutions for dilution.
• Comparing solute clearance and treatment efficiency with postdilution HF.

Main Results:

• Predilution HF significantly increases the filtration fraction and solute clearance compared to postdilution.
• While requiring more infusion solution, on-line preparation makes predilution economically feasible.
• This method facilitates bicarbonate use, improving therapy options.

Conclusions:

• Predilution hemofiltration offers superior solute removal across a wide molecular range.
• It presents a more effective and cost-efficient alternative to traditional postdilution HF.
• This advanced HF modality provides unequalled performance in renal replacement therapy.