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Haemodiafiltration with sorbent-regenerated ultrafiltrate as replacement fluid: a multicenter study
A L de Francisco1, J Botella, R Escallada
1Servicio de Nefrologia, Hospital Universitario Valdecilla, Santander, Spain.
Summary
Regenerating ultrafiltrate with uncoated charcoal is a safe hemodialysis technique. This method effectively removes toxins like beta 2-microglobulin while preserving essential electrolytes, showing excellent patient tolerance.
Area of Science:
- Nephrology
- Biomaterials Science
Background:
- Uncoated adsorbent charcoal can regenerate ultrafiltrate for use as an endogenous substitution fluid.
- Assessing the safety and long-term clinical outcomes of this technique is crucial.
Purpose of the Study:
- To evaluate the safety and long-term clinical efficacy of using uncoated adsorbent charcoal to regenerate ultrafiltrate for hemodialysis.
Main Methods:
- Thirty-three chronic uremic patients underwent a year of hemodialysis using serial dialyzers to separate convection and diffusion.
- A charcoal cartridge was placed after the convective filter, and the regenerated ultrafiltrate was infused into the diffusive dialyzer.
- Ex vivo and in vitro studies analyzed adsorption, aluminum release, trace elements, and microparticles.
Main Results:
- Charcoal passage maintained urea, phosphate, potassium, calcium, and bicarbonate levels.
- Creatinine, uric acid, and beta 2-microglobulin were significantly absorbed.
- Aluminum levels were reduced to pharmacopoeial standards after washing; copper was retained. Regenerated ultrafiltrate was free of microparticles, bacteria, and endotoxins. Clinical tolerance was excellent, with a significant decrease in beta 2-microglobulin at 6 and 12 months.
Conclusions:
- Reinfusion of ultrafiltrate via uncoated charcoal is safe, well-tolerated, and simple.
- This technique may help maintain acid-base balance by reinfusing endogenous bicarbonate.