Divert to ULTRA: differences in infused volumes and clearance in two on-line hemodiafiltration treatments.
BACKGROUND
Mixed diffusive-convective dialysis therapies offer greater removal capabilities than conventional dialysis. The aim of this study was to compare two different on-line, post-dilution hemodiafiltration (HDF) treatments with regard to achieved convective volume and middle-molecule dialysis efficiency: standard volume control (sOL-HDF) and automated control of the transmembrane pressure (TMP) (UC-HDF).


METHODS
We enrolled 30 ESRD patients (55.9 ± 14.0 years, 20/10 M/F) in a randomized, prospective, cross-over study. The patients received a 3-month period of sOL-HDF followed by UC-HDF for a further 3 months, or vice versa, using the same dialysis machine. In sOL-HDF, fixed exchange volumes were set according to a filtration fraction greater than or equal to 25%. In UC-HDF therapy, the exchanged volume was driven by a biofeedback system controlling the TMP and its set point in a double loop. Patients maintained their treatment time, dialyzer, blood flow rate, and anticoagulant regimen unchanged throughout the study.


RESULTS
Greater convective volumes were achieved in UC-HDF than in sOL-HDF (23.8 ± 3.9 vs.19.8 ± 4.8 L; p<0.001) with high pre-dialysis Ht value (sOL-HDF 34.0 ± 4.5% and UC-HDF 34.0 ± 4.4%; p = 0.91). The average clearance values of ß2m and P were higher in UC-HDF than in sOL-HDF (respectively 123 ± 24 vs. 111 ± 22 ml/min, p<0.002 and 158 ± 26 vs. 152 ± 25 ml/min, p<0.05). Moreover, the UC-HDF mode led to a significantly increased rate of call-free sessions from 88% to 97% (p<0.0001).


CONCLUSIONS
This study showed that the biofeedback module, applied to the automatic control of TMP in on-line HDF, results in higher convective volumes and correspondingly higher ß2m and P clearances. By making the HDF treatment more automated and less complex to perform, it significantly reduced the staff workload.
Dialysis and Nephrology Unit, Versilia Hospital, Lido of Camaiore - Italy. v.panichi@usl12.toscana.it
Vincenzo
V
Panichi
Giacomo
G
De Ferrari
Stefano
S
Saffioti
Antonino
A
Sidoti
Marina
M
Biagioli
Stefano
S
Bianchi
Patrizio
P
Imperiali
Claudio
C
Gabbrielli
Paolo
P
Conti
Pietro
P
Patrone
Valeria
V
Falqui
Giuseppe
G
Rombolà
Carlo
C
Mura
Andrea
A
Icardi
Donatella
D
Mulas
Alberto
A
Rosati
Francesco
F
Santori
Antonio
A
Mannarino
Valeria
V
Tomei
Andrea
A
Bertucci
Denis
D
Steckiph
Roberto
R
Palla
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001331:Automation; D015415:Biomarkers / Q000097:blood; D018592:Cross-Over Studies; D004867:Equipment Design; D005246:Feedback; D005260:Female; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000097:blood / Q000451:nursing / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D011312:Pressure; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload; D001613:beta 2-Microglobulin / Q000097:blood
D000925:Anticoagulants; D015415:Biomarkers; D008567:Membranes, Artificial; D010710:Phosphates; D001613:beta 2-Microglobulin