[Mid-dilution hemodiafiltration].
On-line mid-dilution hemodiafiltration is a convective mixed therapy with improved middle-molecule removal compared to standard HDF. The main feature of the method is the exclusive design of two dialyzers in series (OLpūr™), which allow combined postdilution and predilution HDF. Substitution fluid is infused after the first filter and before passage of the blood through the second filter. In this configuration, a postdilution HDF stage is followed by a predilution HDF stage. The method was subsequently optimized by reversing the two phases of reinfusion. The reverse configuration using the filter at a higher surface better preserves membrane permeability, allowing more efficient removal of medium-molecular-weight solutes. The technique can be performed with new-generation dialysis monitors equipped for on-line preparation of sterile infusion fluids. Several studies have confirmed the clinical benefits observed, including high phosphate and beta2-microglobulin removal and improved cardiovascular stability.
U.O.C. di Nefrologia e Dialisi, Ospedale Maggiore, A.O. della Provincia di Lodi, Lodi, Italy. nefrodialisi.lodi@ao.lodi.it
Salvatore
S
Mandolfo
D004867:Equipment Design; D017583:Hemodiafiltration / Q000295:instrumentation* / Q000379:methods*; D015312:Hemodialysis Solutions; D006801:Humans
D015312:Hemodialysis Solutions