title: Elevated removal of middle molecules without significant albumin loss with mixed-dilution hemodiafiltration for patients unable to provide sufficient blood flow rates.
abstract: BACKGROUND
  We examined the hypothesis that mixed-dilution online hemodiafiltration (MIXED) rather than predilution online hemodiafiltration (PRE) could enable patients with low blood flow rate (Qb) to benefit from advantages of convective therapies.
  
  
  METHODS
  Thirty-eight patients were included in a prospective, randomized, crossover and multicenter study conducted with a view to comparing the equilibrated Kt/V, reduction ratio (RR) of phosphates, β2-microglobulin (β2-M) and myoglobin (myo) between PRE and MIXED, each at two Qb values of 250 and 300 ml/min during 4 h sessions with a FX1000HDF dialyzer. Albumin losses (Alb) were also measured in 12 patients.
  
  
  RESULTS
  MIXED was always found to be more efficient compared to PRE notably for middle molecules (MM). RRβ2-M: MIX250: 81.3 ± 3.6 vs. PRE250: 75.2 ± 5.9; MIX300: 82.7 ± 3.6 vs. PRE300: 78.1 ± 5.4; RRmyo: MIX250: 70.2 ± 3.6 vs. PRE250: 42.6 ± 2.6; MIX300: 70.6 ± 3.6 vs. PRE300: 45.7 ± 3.6 and with Alb <3.0 g/session.
  
  
  CONCLUSIONS
  MIXED allows patients unable to provide sufficiently high Qb to achieve high levels of MM removal.
authors.affiliation: Dialysis Unit, Centre Hospitalier, Cherbourg, France.
authors.forename: Jacky
authors.initials: J
authors.lastname: Potier
authors.forename: Frank
authors.initials: F
authors.lastname: Le Roy
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Faucon
authors.forename: Thibault
authors.initials: T
authors.lastname: Besselièvre
authors.forename: Eric
authors.initials: E
authors.lastname: Renaudineau
authors.forename: Christian
authors.initials: C
authors.lastname: Farquet
authors.forename: Pascale
authors.initials: P
authors.lastname: Soihan
authors.forename: Dominique
authors.initials: D
authors.lastname: Touzard
authors.forename: Asia
authors.initials: A
authors.lastname: Djema
authors.forename: Toma
authors.initials: T
authors.lastname: Ilinca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012079:Renal Circulation; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology / Q000628:therapy*; D012709:Serum Albumin / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin