Rationale and experience with short daily hemofiltration.
Patients with end-stage renal disease (ESRD) have morbidity and mortality rates that are much higher than those found in the general population. The nonphysiologic nature of thrice-weekly hemodialysis may be partially responsible for the poor outcomes in this patient population. In response to the problems encountered with conventional hemodialysis schedules, a number of investigators have explored potential solutions to the problem. One such solution is to increase the time and/or frequency of hemodialysis. With this approach, ESRD patients have been observed to have better anemia management and blood pressure control, as well as improvements in quality of life. Hemodialysis is based on diffusion of solutes across a semipermeable membrane such that only small molecules are readily removed. Therefore a second solution has been to utilize hemofiltration instead of hemodialysis. Hemofiltration utilizes convective clearance of molecules, resulting in an improvement in the removal of larger solutes, much like the glomerular basement membrane of the kidney. Despite the accumulated evidence that thrice-weekly hemofiltration adds to the benefits seen with increasing hemodialysis time and/or frequency, the use of hemofiltration has been limited by the available technology, cost, and low access blood flows. However, current technological advances in equipment and access creation are addressing these problems. With these advances, a number of investigators have also explored the potential benefits of daily hemofiltration as a treatment option for ESRD. The preliminary results suggest that improvements in blood pressure, beta2-microglobulin (beta2M) levels, and quality of life are possible.
Jaber
Bertrand L
BL
Division of Nephrology, Tufts-New England Medical Center, Boston, MA, USA.
Zimmerman
Deborah L
DL
D001071:Appointments and Schedules; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008567:Membranes, Artificial
D008567:Membranes, Artificial