title: Comparison of middle-molecule clearance between convective control double high-flux hemodiafiltration and on-line hemodiafiltration.
abstract: Hemodiafiltration (HDF) is now a well-recognized treatment modality for end-stage renal disease (ESRD) patients. It provides superior characteristics over conventional hemodialysis in many respects. On-line HDF, however, which has been mainly used in clinical practice, requires a special machine. Interestingly, the recently innovated convective-control double high-flux hemodiafiltration (CC-DHF) machine can provide HDF treatment with an adjustable convection rate by using the conventional volume-controlled dialysate flow hemodialysis machine in a modified way. The present study was conducted to compare the efficacy of CC-DHF compared to on-line HDF in terms of middle and small solute clearances in 12 stable, chronic hemodialysis patients who underwent hemodialysis three times a week for at least 6 months. The results showed that the beta 2-microglobulin (beta 2M) removal represented by the beta 2M clearance in CC-DHF was comparable to that in on-line HDF (112.4+/-17.0 vs. 119.4+/-15.5 ml/min respectively, NS). Also, the beta 2M reduction ratio in the CC-DHF group did not differ from the on-line HDF group (85.5+/-4.2% vs. 86.1+/-6.7%, NS). With regard to small solute clearances, the values of single-pool Kt/V and phosphate clearance did not differ between CC-DHF and on-line HDF groups. In conclusion, CC-DHF provides removal of beta 2M and small molecule uremic toxins that is comparable to on-line HDF. An on-line HDF machine may not be available in all hemodialysis centers, whereas CC-DHF can be easily set up, with proper precautions regarding the fluid quality. Therefore, CC-DHF can provide the benefits of convective therapy to patients in situations where use of an on-line HDF machine is limited.
authors.affiliation: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Tiranathanagul
authors.forename: C
authors.initials: C
authors.lastname: Yossundharakul
authors.forename: N
authors.initials: N
authors.lastname: Techawathanawanna
authors.forename: P
authors.initials: P
authors.lastname: Katavetin
authors.forename: O
authors.initials: O
authors.lastname: Hanvivatvong
authors.forename: K
authors.initials: K
authors.lastname: Praditpornsilp
authors.forename: K
authors.initials: K
authors.lastname: Tungsanga
authors.forename: S
authors.initials: S
authors.lastname: Eiam-Ong
mesh_terms: D000328:Adult; D018481:Convection; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009862:Online Systems; D011446:Prospective Studies; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000378:metabolism*
chemical_list: D001613:beta 2-Microglobulin