title: Daily ultrafiltration results in improved blood pressure control and more efficient removal of small molecules during hemodialysis.
abstract: BACKGROUND
  Although prior studies have shown that frequent hemodialysis (HD) can lead to improved control of dry weight in end-stage renal disease patients, there are no clinical studies examining whether this can improve blood pressure (BP) control and can also shorten the dialysis time needed to achieve satisfactory removal of small molecules. Several models of wearable dialysis systems are now under various stages of development. These devices present the possibility of hemodialyzing patients to their dry weights. We have built a prototype of a wearable ultrafiltration (UF) device that can provide daily UF. Apart from better fluid control, we hypothesize that separating HD from UF will result in better BP control, and adequate weekly small molecule removal could be achieved with a decreased duration of dialysis. We tested the hypothesis in current HD patients using conventional dialysis equipment.
  
  
  METHODS
  Thirteen patients were selected from a large urban HD center. The experimental period consisted of 4 weeks of daily UF (4 days/week of UF alone and 2 days/week of HD with UF). The duration of the HD sessions was increased by 15-30 min to maintain weekly standard Kt/V >2.0. The patients were then returned to their conventional 3 days/week of HD with UF and studied for 4 weeks. Predialysis BPs, interdialytic weight gains, and Kt/V results of the experimental and return periods were compared with those of the 3-month control period. No changes were made in antihypertensive or other medication during the study.
  
  
  RESULTS
  During the experimental period, mean arterial pressure decreased from 110 to 95 mm Hg (p < 0.001), systolic BP from 158 to 136 mm Hg (p < 0.001), while interdialytic weight gains were reduced from 3.25 to 1.21 liters (p < 0.0001). During the experimental period, weekly standard Kt/V of 2.16 was achieved in 8.24 h/week of HD, as compared to 11.14 h/week.
  
  
  CONCLUSIONS
  Volume control with daily UF results in improved BP control and, by separating the UF function from HD, adequate weekly standard Kt/V >2 can be achieved with twice weekly HD.
authors.affiliation: Division of Nephrology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA. jajones@chpnet.org
authors.forename: James P
authors.initials: JP
authors.lastname: Jones
authors.forename: Edward F
authors.initials: EF
authors.lastname: Leonard
authors.forename: Gagangeet
authors.initials: G
authors.lastname: Sandhu
authors.forename: Gary
authors.initials: G
authors.lastname: Winkel
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Stanley
authors.initials: S
authors.lastname: Cortell
mesh_terms: D001794:Blood Pressure; D001826:Body Fluids / Q000737:chemistry; D001835:Body Weight; D017097:Electric Impedance; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011788:Quality of Life