Hemofiltration or hemodiafiltration with on-line production of substitution fluid: clinical observation of safety and effectiveness.
OBJECTIVE
To observe the safety and cardiovascular stability of on-line hemofiltration (HF) or hemodiafiltration (HDF) and evaluate the clinical effectiveness of one HF or HDF session in addition to two hemodialysis (HD) sessions weekly.


METHODS
Forty patients were randomly divided into four groups: group predilutional (PRD) HF (filtration rate: 259-333 ml/min) group predilutional HDF (filtration rate: 167 ml/min) group postdilutional (POD) HDF (filtration rate: 83 ml/min) and group bicarbonate HD. The reduction rate of parathyroid hormone (PTH), beta 2-microglobulin (beta 2MG), alpha 1-microglobulin (alpha 1MG) and KT/V in the initial treatment of every month was observed, and the incidence of hypotension and pyretic reaction during each treatment was evaluated.


RESULTS
After 4-month observation, the KT/V for Group POD HDF is better than that for the other three groups, and for Group PRD HDF is better than that for Group HF and HD. Serum level of PTH and beta 2MG was not decreased after every treatment in Group HD, and so was serum level of alpha 1MG in all groups. Significant removal of PTH and beta 2MG was observed in Group HF, PRD HDF and POD HDF. The monthly serum level of beta 2MG and KT/V were stable in all groups, but the monthly serum level of PTH tended to be decreased in Group HF, PRD, HDF, and POD HDF. The incidence of pyretic reaction in HF or HDF was the same as in HD. Although the ultrafiltration volume was significantly higher during HF or PRD HDF than during HD, the incidence of hypotension in HF or PRD HDF was similar to that in HD.


CONCLUSIONS
On-line HF or HDF proved to be a safe and reliable method. POD HDF mode seems to have the best KT/V, HF or PRD HDF offers a better choice for preventing intradialytic hypotension. One HF or HDF session in addition to two HD sessions weekly is similarly effective to decrease the serum level of PTH and the proof of the clinical effectiveness of such a therapy awaits a long-term observation.
Li
X
X
Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China.
Li
M
M
Liu
T
T
Li
L
L
Duan
L
L
Li
Y
Y
Yang
G
G
Guo
L
L
D000328:Adult; D000368:Aged; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects; D006440:Hemofiltration / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000032:analysis
D010281:Parathyroid Hormone; D001613:beta 2-Microglobulin