title: [Hemodiafiltration with on-line production of bicarbonate infusate: 5 years of clinical experience].
abstract: Despite its potential advantages HDF has not gained large clinical acceptance among nephrologist due to its technical complexity and to the large quantity of pharmaceutical substitution fluid needed. HDF with on-line production of substitution fluid from dialysate simplifies the procedure and reduces the cost of treatment session. We treated regularly 13 high risk and/or non-compliant patients (9 males, 4 females) with HDF for 46 +/- 17 months. HDF program consisted of 3 sessions weekly lasting 210 +/- 10 mn with blood flow rate 350 +/- 20 ml/mn and fluid volume exchange of 20 liters/session. High flux dialyzers (HF80, Filtral 16) were reused 6 to 13 times automatically on a Renatron machine with peroxyacetic acid solution as sole cleaning and disinfecting agent. Microbiologic quality of infusate was assessed by membrane filtration culturing method and LAL endotoxin determination. 3937 HDF sessions were performed. 57.140 I of substitution fluid were infused IV to patients. Eight pyrogenic reactions were observed: 2 due to septicemia related to catheter infection and 6 from unknown origin. Adequacy of program was achieved in all patients. Blood pressure control was satisfactorily obtained without antihypertensive medication in 12/13 patients. Effective weekly integrated urea clearances was 150 +/- 15 l/wk, KT/V index was 1.50 +/- 0.10, urea TAC 20 +/- 2 mM/l and protein catabolic rate 1.40 +/- 0.10 g/kg/24 h. We conclude that HDF with on-line production of bicarbonate substitution fluid is a safe and highly efficient method cost-competitive with bicarbonate HD, which offers an interesting alternative for renal replacement therapy.
authors.affiliation: Service de Néphrologie, Hôpital Lapeyronie, Montpellier, France.
authors.forename: B
authors.initials: B
authors.lastname: Canaud
authors.forename: Q V
authors.initials: QV
authors.lastname: N'Guyen
authors.forename: C
authors.initials: C
authors.lastname: Bouloux-Polito
authors.forename: F
authors.initials: F
authors.lastname: Stec
authors.forename: C
authors.initials: C
authors.lastname: Mion
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates; D005069:Evaluation Studies as Topic; D005260:Female; D015312:Hemodialysis Solutions; D006440:Hemofiltration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control
chemical_list: D001639:Bicarbonates; D015312:Hemodialysis Solutions
vernacular_title: Hémodiafiltration (HDF) avec production "en ligne" d'infusat au bicarbonate: 5 ans d'expérience clinique.