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Canziani MEF, Strogoff-de-Matos JP, Guedes M, Barra ABL, Canhada S, Carvalho L, Gemente D, Poli-de-Figueiredo CE, Pecoits-Filho R. High volume online hemodiafiltration: a global perspective and the Brazilian experience. J Bras Nefrol 2024; 46:e20230104. [PMID: 38134298 DOI: 10.1590/2175-8239-jbn-2023-0104en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/12/2023] [Indexed: 12/24/2023] Open
Abstract
Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient - reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.
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Affiliation(s)
| | | | - Murilo Guedes
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Cho AJ, Park HC, Kim DH, Choi HB, Song GH, Kim H, Kim SH, Choi G, Kim JK, Song YR, Yoon JW, Lee YK. Impact of needle type on substitution volume during online hemodiafiltration: plastic cannulae versus metal needles. Kidney Res Clin Pract 2023; 42:117-126. [PMID: 36328989 PMCID: PMC9902740 DOI: 10.23876/j.krcp.21.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/17/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Plastic cannulae have attracted increasing interest as an alternative to traditional metal needles with the aim of reducing cannulation-related complications. We investigated whether the substitution volumes during hemodiafiltration differ using these two types of needles in dialysis patients. METHODS An intervention study involving 26 hemodialysis patients was conducted in Korea between March and September in 2021. Patients first received online hemodiafiltration using traditional metal needles, and thereafter plastic cannulae were used in a stepwise protocol. Repeated-measures design and linear mixed-effect models were used to compare substitution volumes between the two needle types with the same inner diameter. RESULTS The mean patient age was 62.7 years, and their mean dialysis vintage was 95.2 months. Most patients (92.3%) had an arteriovenous fistula as the vascular access. The substitution volume increased as blood flow and needle size increased for both plastic cannulae and metal needles. The substitution volume was significantly higher with 17-gauge (G) plastic cannulae than with 16-G metal needles at blood flow rates of 280, 300, and 330 mL/min. Similar results were obtained for 15-G metal needles and 16-G plastic cannulae at a blood flow rate of 330 mL/min. However, the patient ratings of pain on a visual analogue scale were higher for plastic cannulae. CONCLUSION Higher substitution volumes were obtained at the same prescribed blood flow rate with plastic cannulae than with metal needles during online hemodiafiltration. Plastic cannulae are an option for achieving high-volume hemodiafiltration for patients with low blood flow rates.
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Affiliation(s)
- AJin Cho
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Han Byul Choi
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Gi Hyun Song
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Seok-hyung Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Gwangho Choi
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea,Jong-Woo Yoon Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Republic of Korea. E-mail:
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea,Hallym University Kidney Research Institute, Seoul, Republic of Korea,Correspondence: Young-Ki Lee Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. E-mail:
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Nenadović M, Nikolić A, Stanojević-Pirković M, Trbojević-Stanković J, Nikolić T, Petrović D, Djulejić V. Assessment of the Influence of Asymmetric Triacetate Cellulose Membrane on the Rate of Removal of Middle Molecular Weight Uremic Toxins in Patients Treated with Postdilution Online Hemodiafiltration. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND: Postdilution online hemodiafiltration (OL-HDF) effectively removes uremic toxins of middle molecular weight from the blood of patients with end-stage chronic kidney disease. The rate of removal of uremic toxins depends on the type of dialysis membrane, blood flow rate (Qb), net ultrafiltration flow rate (Qnuf), and total convective volume (Vconv).
AIM: The aim of this study was to examine the efficacy of asymmetric triacetate cellulose dialysis membrane in patients on post-dilution OL-HDF.
METHODS: Thirty-five patients treated with post-dilution OL-HDF hemodiafiltration for at least 3 months were examined. The main parameters for assessing the efficiency of removal of uremic toxins of middle molecular weight are the concentration of β2-microglobulin (β2-M) and interleukin-6 (IL-6) in serum before and after a single session of post-dilution OL-HDF. The followings were used for statistical analysis: Kolmogorov–Smirnov test, Student’s T test for bound samples and Wilcoxon test.
RESULTS: The average Vconv was 20.90 ± 3.30 liters/session. The β2-M reduction index during a single session of postdilution OL-HDF was 71.10 ± 6.39%, the IL-6 reduction index was 43.75 ± 15.60%, and the albumin reduction index was 4.55 ± 2.31%.
CONCLUSION: The asymmetric triacetate cellulose dialysis membrane effectively removes β2-M and IL-6 during a single session of postdilution OL-HDF. The β2-M reduction index is ∼70%, the IL-6 reduction index is ∼40%, and albumin loss is <4.0 g/4 h. The examined dialysis membrane and dialysis modality prevent the development of amyloidosis associated with dialysis, microinflammation and reduce the risk of developing atherosclerotic cardiovascular diseases in the population of patients treated with regular hemodiafiltration.
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Canaud B, Davenport A. Prescription of online hemodiafiltration (ol-HDF). Semin Dial 2022; 35:413-419. [PMID: 35297521 DOI: 10.1111/sdi.13070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 12/28/2022]
Abstract
HDF prescription should be able to satisfy the delivery of an optimal dialytic convective dose. Several factors are implicated in this endeavor. High blood flow rate is crucial to warranty processing an adequate blood volume and to ensure the highest shear rate per fiber needed to cleanse and prevent membrane fouling. A highly permeable dialyzer is needed with a surface area aligned to blood flow and performance needs. Anticoagulation requires specific adaptation in case of low molecular weight heparin use. By default, HDF prescription modality should ideally start by postdilution mode with a stepwise increment of convective dose by probing patient tolerance and efficacy. Alternative substitution modality should be considered if dialytic convective dose could not be achieved in the usual time frame. Convective dose prescription relies either on a manual mode (pressure control or volume control) or on automated mode (ultrafiltration control) depending on the technical options of the HDF machines. Dialysate flow rate is regulated by the HDF machine but should preferably keep constant dialysis fluid flowing the dialyzer with a Qb:Qd ratio of 1.4. Treatment time should not be reduced with HDF prescription. Treatment time should fit with patient tolerance (hemodynamic, osmotic, and solute shifts) and overall solute removal efficiency. Electrolytic prescription does not require specific adjustments as compared with conventional dialysis, but the patient needs to be monitored regularly and dialysate electrolyte adjusted to lab tests. A stepwise approach for implementing ol-HDF is preferable depending on the initial condition of the patient. Three particular cases may be considered: late-stage chronic kidney disease patient transitioning to renal replacement therapy, stable dialysis patient switching to HDF, and unstable or fragile patient or specific treatment schedule. Optimal dosing of HDF and personalized care to ensure treatment adequacy is the main goal for renal replacement therapy to improve patient outcomes. That should be ensured with HDF treatment.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, Montpellier, France.,Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - Andrew Davenport
- University College London Department of Renal Medicine, Royal Free Hospital, University College, London, UK
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Park HC, Lee YK. Who is the winner, pre-, post-, or mixed-dilution hemodiafiltration? Kidney Res Clin Pract 2021; 40:332-334. [PMID: 34510854 PMCID: PMC8476302 DOI: 10.23876/j.krcp.21.172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
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