A simple efficient technique of 'mid-dilution' on-line hemodiafiltration.
BACKGROUND
On-line hemodiafiltration (OL-HDF) with pre- as well as post-dilution reinfusion mode provides superior uremic toxin removal, especially middle uremic toxins, and can improve patient survival. Both standard pre- and post-dilution have limitations. Mid-dilution OL-HDF (Nephros OLpur) was invented to overcome the disadvantages of both standard modes, but such a cartridge is only available in limited centers and is expensive.


METHODS
We created a simple technique of mid-dilution OL-HDF that can be easily set up in every hemodialysis center. Twelve stable end-stage renal disease patients were dialyzed in a random sequence with three different infusion modes of OL-HDF (simple mid-dilution, standard pre-dilution and post-dilution). Small molecule, middle molecule, and protein-bound uremic toxin clearances were measured.


RESULTS
Simple mid-dilution OL-HDF provided high efficiency in uremic toxin clearances with less protein loss.


CONCLUSIONS
Simple mid-dilution OL-HDF combines the advantages of pre- and post-dilution modes without adverse effects. Thus, this technique could be useful in decreasing morbidity and mortality in hemodialysis patients.
Susantitaphong
Paweena
P
Extracorporeal Multiorgan Support Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Tiranathanagul
Khajohn
K
Hanvivatvong
Orrawadee
O
Homsin
Uthaiwan
U
Wittayalertpanya
Supeecha
S
Khemsri
Wandee
W
Praditpornsilpa
Kearkiat
K
Eiam-Ong
Somchai
S
D000368:Aged; D003408:Cresols / Q000302:isolation & purification; D004867:Equipment Design; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged
D003408:Cresols; C077977:cresol