Stepwise achievement of high convection volume in post-dilution hemodiafiltration: A prospective observational study.
Semin Dial
; 34(5): 368-374, 2021 09.
Article
in En
| MEDLINE
| ID: mdl-33774852
ABSTRACT
High-volume online hemodiafiltration (HDF) has been reported to reduce the patient's mortality. However, achieving a high convection volume is challenging. In this prospective study, we investigated the feasibility of achieving high-volume HDF with ≥21 L substitution volume via modification of blood flow rate (BFR), needle size, and dialysis membrane. In 30 patients undergoing hemodialysis, we followed a stepwise protocol and gradually increased the BFR (280â300â330 ml/min; steps 1, 2, and 3) and needle size (16â15 G; step 4). After changing dialyzer surface area (1.8 m2 â2.5 m2 ), the BFR and needle size were similarly increased stepwise (steps 5, 6, 7, and 8). The mean substitution volume was 18.7 ± 2.2 L at step 1 and it significantly increased to 25.1 ± 2.6 L by step 8. A substitution volume of 21 L was achieved by 13.3% of patients in step 1 and by 96.7% after step 8. The substitution volume was higher for the dialyzer with a large surface area and for the larger needle (15 G). Between steps 1 and 8, the Kt/V and ß2 microglobulin reduction ratios also improved significantly. High-volume HDF is feasible through a stepwise increase in the BFR, needle size, and surface area of the dialysis membrane.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hemodiafiltration
Type of study:
Observational_studies
Limits:
Humans
Language:
En
Journal:
Semin Dial
Journal subject:
NEFROLOGIA
Year:
2021
Type:
Article