Divert to ULTRA: Differences in Infused Volumes and Clearance in Two On-Line Hemodiafiltration Treatments

• Published in: International journal of artificial organs 2012-06, Vol.35 (6), p.435-443
• Main Authors: Panichi, Vincenzo, De Ferrari, Giacomo, Saffioti, Stefano, Sidoti, Antonino, Biagioli, Marina, Bianchi, Stefano, Imperiali, Patrizio, Gabbrielli, Claudio, Conti, Paolo, Patrone, Pietro, Falqui, Valeria, Rombolà, Giuseppe, Mura, Carlo, Icardi, Andrea, Mulas, Donatella, Rosati, Alberto, Santori, Francesco, Mannarino, Antonio, Tomei, Valeria, Bertucci, Andrea, Steckiph, Denis, Palla, Roberto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - therapeutic use; Automation; beta 2-Microglobulin - blood; Biological and medical sciences; Biomarkers - blood; Cross-Over Studies; Emergency and intensive care: renal failure. Dialysis management; Equipment Design; Feedback; Female; Hemodiafiltration - instrumentation; Hemodiafiltration - methods; Hemodiafiltration - nursing; Humans; Intensive care medicine; Italy; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - nursing; Kidney Failure, Chronic - therapy; Male; Medical sciences; Membranes, Artificial; Middle Aged; Phosphates - blood; Pressure; Prospective Studies; Time Factors; Treatment Outcome; Workload
• ISSN: 0391-3988; 1724-6040
• DOI: 10.5301/ijao.5000106

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, crossover 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