Pre-postdilution haemofiltration.

Postdilution haemofiltration is a treatment indicated for patients who are unable to tolerate standard dialysis. However, its duration is uncomfortably prolonged in cases of low blood flow from the vascular access. In a predilution mode greater clearance rates can be reached even if a greater amount of sterile and pyrogen-free solutions are required. Although an in-line solution-producing system lowers the cost, theoretical calculations indicate that a predilution mode is not advantageous, in terms of the amount of infused solutions, if urea clearances greater than 150 ml/min at 300 ml/min blood flow are required. Theoretically, the combination of predilution and postdilution is the best system to utilise relatively small amounts of sterile solution in order to enhance treatment efficiency at low blood flow. However, the predilution mode may ultimately be preferable because of easier utilisation of the hardware. The results of clinical application of pre-postdilution haemofiltration indicate that at a 400 ml/min blood flow, a urea clearance of more than 220 ml/min can be obtained, and the duration of treatment can be reduced to only 3 h in the majority of patients.