title: [On-line hemodiafiltration with endogenous reinfusion (HFR). Experience of a Centre].
abstract: OBJECTIVE
  Hemodiafiltration reinfusion (HFR) treatment is a dialysis technique that uses the endogenous reinfusion fluid and performs, simultaneously and separately, the three mechanisms of extracorporal depuration: diffusion, convection and adsorption. This study aimed to evaluate clinical and biochemical data of a group of six patients submitted to a dialytic HFR method for >6 months.
  
  
  METHODS
  Six patients with a mean age of 53.8 +/- 11 yrs (five males, one female), treated with standard bicarbonate dialysis for a mean of 79.2 months, underwent HFR for a mean period of 14.9 +/- 6 months. Filters used were: a) in all patients polysulfone with 0.7 m2 of surface for the convection; b) polysulfone with 1.7 m2 in one patient, and modified cellulose with 2.0 m2 in five patients for diffusion; c) hydrophobic interaction resin and uncovered mineral carbon 240 mL for the adsorption. For all patients dialysis duration was 240 min and the amount of reinfusion fluid was 2.5 L/h as a mean, calculated according to blood flow and hematocrit (Hct), keeping a filtration fraction <22%. We evaluated, at different times, the following parameters: a) patient weight; b) Hct and erythropoietin (EPO) doses; c) parathyroid hormone (PTH); d) phosphatemia and doses of administered vitamin D; e) homocysteine (Hcy) and Beta2-microglobulin (Beta2-m); f) and albuminemia and transferrinemia as nutritional parameters.
  
  
  RESULTS
  We observed an increase in Hct, with a reduction in EPO dosage, and an increase in albumin and transferrin levels, an improvement in nutritional indexes and in patient well-being. The mild increase in Hct with the same EPO dose was present in spite of a switch to intravenous (i.v.) administration from subcutaneous administration. There was low morbidity and only one hospitalization due to an infectious episode.
  
  
  CONCLUSIONS
  HFR allows an amino acid saving and pro-inflammatory middle molecule removal, resulting in a better clinical situation for progressively critical uremic patients.
authors.affiliation: Unita' Operativa di Nefrologia e Dialisi, Policlinico MultiMedica, Sesto San Giovanni, Milan.
authors.forename: C
authors.initials: C
authors.lastname: Ballabeni
authors.forename: M
authors.initials: M
authors.lastname: Maccario
authors.forename: D
authors.initials: D
authors.lastname: Ciurlino
authors.forename: S
authors.initials: S
authors.lastname: Martino
authors.forename: F
authors.initials: F
authors.lastname: Tentori
authors.forename: G
authors.initials: G
authors.lastname: Bigatti
authors.forename: S V
authors.initials: SV
authors.lastname: Bertoli
mesh_terms: D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014511:Uremia / Q000097:blood / Q000628:therapy*
chemical_list: D015312:Hemodialysis Solutions