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.
Extracorporeal Multiorgan Support Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Paweena
P
Susantitaphong
Khajohn
K
Tiranathanagul
Orrawadee
O
Hanvivatvong
Uthaiwan
U
Homsin
Supeecha
S
Wittayalertpanya
Wandee
W
Khemsri
Kearkiat
K
Praditpornsilpa
Somchai
S
Eiam-Ong
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