Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration.
BACKGROUND
Daily dialysis has shown excellent clinical results because a higher frequency of dialysis is more physiologic. On-line hemodiafiltration (OL-HDF) is a HDF technique that combines diffusion with high convection in which the dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (on-line HDF).


METHODS
Eight patients, six males and two females, on standard 4 to 5 hours three times a week OL-HDF (S-OL-HDF) were switched to daily OL-HDF (D-OL-HDF) 2 to 21/2 hours six times per week. Dialysis parameters were identical during both periods and only frequency and dialysis time of each session were changed. Tolerance, uremic toxin removal, urea kinetics, biochemical and anemia profiles, blood pressure, and left ventricular hypertrophy were evaluated.


RESULTS
D-OL-HDF was well accepted and tolerated. The disappearance of postdialysis fatigue was rapidly reported by patients. Patients mantained the same [time average concentration (TAC) and weekly single-pool Kt/V (spKt/V)] throughout the study. However, equivalent renal urea clearance (EKR), standard Kt/V and weekly urea reduction ratio (URR) were increased during D-OL-HDF. Weekly urea, creatinine, osteocalcin, beta2-microglobulin, myoglobin, and prolactin reduction ratios were improved with D-OL-HDF. There was a significant decrease in predialysis plasma levels of urea, creatinine, acid uric, beta2-microglobulin and homocysteine over 6 months. Phosphate binders were reduced and antihypertensive drugs were stopped. A 30% regression of left ventricular mass was observed.


CONCLUSIONS
The change from S-OL-HDF to D-OL-HDF was well tolerated. Disappearance of postdialysis fatigue, better dialysis adequacy, a higher removal of middle and large molecules, a reduction of phosphate binders, improvement of status nutritional, and an important reduction of cardiovascular risk factors were observed.
Maduell
Francisco
F
Department of Nephrology, Hospital General de Castellón, Spain. maduell_fra@gva.es
Navarro
Victor
V
Torregrosa
Eduardo
E
Rius
Asunción
A
Dicenta
Fernando
F
Cruz
Maria Carmen
MC
Ferrero
J Antonio
JA
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D005260:Female; D006321:Heart / Q000503:physiopathology; D017583:Hemodiafiltration; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis; D007674:Kidney Diseases / Q000503:physiopathology / Q000628:therapy*; D007700:Kinetics; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D011159:Population Surveillance; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome