Stepwise achievement of high convection volume in post‐dilution hemodiafiltration: A prospective observational study

• Published in: Seminars in dialysis 2021-09, Vol.34 (5), p.368-374
• Main Authors: Kim, Do Hyoung, Lee, Young‐Ki, Park, Hayne Cho, Kim, Juhee, Yun, Kyu Sang, Cho, AJin, Noh, Jung‐Woo, Kim, Hyunsuk, Kim, Seok‐hyung, Yoon, Jong‐Woo
• Format: Article
• Language: English
• Subjects: beta 2-Microglobulin; Convection; Hemodiafiltration - methods; Humans; Prospective Studies; Renal Dialysis
• ISSN: 0894-0959; 1525-139X
• DOI: 10.1111/sdi.12966

High‐volume online hemodiafiltration (HDF) has been reported to reduce the patient's mortality. However, achieving a high convection volume is challenging. In this prospective study, we investigated the feasibility of achieving high‐volume HDF with ≥21 L substitution volume via modification of blood flow rate (BFR), needle size, and dialysis membrane. In 30 patients undergoing hemodialysis, we followed a stepwise protocol and gradually increased the BFR (280→300→330 ml/min; steps 1, 2, and 3) and needle size (16→15 G; step 4). After changing dialyzer surface area (1.8 m2→2.5 m2), the BFR and needle size were similarly increased stepwise (steps 5, 6, 7, and 8). The mean substitution volume was 18.7 ± 2.2 L at step 1 and it significantly increased to 25.1 ± 2.6 L by step 8. A substitution volume of 21 L was achieved by 13.3% of patients in step 1 and by 96.7% after step 8. The substitution volume was higher for the dialyzer with a large surface area and for the larger needle (15 G). Between steps 1 and 8, the Kt/V and β2 microglobulin reduction ratios also improved significantly. High‐volume HDF is feasible through a stepwise increase in the BFR, needle size, and surface area of the dialysis membrane.