Evaluation of low-volume post-dilution online hemodiafiltration with Japanese high-performance hemodiafilters

• Published in: Journal of artificial organs 2020-09, Vol.23 (3), p.234-239
• Main Authors: Sakurai, Kenji, Hosoya, Hiromi, Kurihara, Yoshitaka, Yamauchi, Fumi, Suzuki, Ayumi, Kurosawa, Kaori, Saito, Takeshi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Albumins; Alpha-Globulins; beta 2-Microglobulin; Biomedical Engineering and Bioengineering; Blood flow; Cardiac Surgery; Dialysis Solutions; Dilution; Efficiency; Female; Flow velocity; Hemodiafiltration - instrumentation; Hemodiafiltration - methods; Humans; Japan; Kidney Failure, Chronic - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original; Original Article; Prospective Studies; Reduction; Solutes; β2 Microglobulin
• ISSN: 1434-7229; 1619-0904
• DOI: 10.1007/s10047-020-01167-y

Purpose To assess the removal performance of low-volume post-hemodiafiltration (HDF) with Japanese hemodiafilters and the removal performance with 20 % reduction in the total dialysate flow rate ( Q d total). Methods Subjects were 8 patients undergoing pre-HDF. Study 1: Post-HDF was performed at a blood flow rate ( Q b ) of 250 mL/min and a total volume of substitution fluid (Vs) of 12 L/session(s) for 4 hrs using Fineflux-210Seco (FIX), ABH-21PA (ABH), and NVF-21H (NVF). We assessed removal efficiency of small molecular solutes, low-molecular-weight-proteins and the amount of albumin loss. Study 2: Post-HDF was performed at Vs of 12 L/s under G-1, Q d total of 500 and Q b of 250 mL/min; G-2, Q d total of 400 and Q b of 250 mL/min; and G-3, Q d total of 400 and Q b of 300 mL/min. Removal efficiency was compared and analyzed between these conditions. Results Study 1: The results using FIX, ABH and NVF are shown in order. The Kt/ V were 1.8, 1.9 and 1.8. The β 2 -Microglobulin (MG) removal rate (RR) (%) were 81.2, 83.1 and 82.8, and the α 1 -MG RR were 37.4, 40.2 and 38.5, respectively. Study 2: The results in G-1, 2 and 3 are shown in order. The Kt/ V and the RR of small solutes, were significantly higher in G-3. The β 2 -MG RR (%) were 81.2, 80.1 and 81.0, and the α 1 -MG RR were 37.4, 37.5 and 38.0, respectively. Conclusions Low-volume post-HDF performed at Q b of 250 mL/min with Japanese high-performance hemodiafilters exhibited favorable removal efficiency for all solutes. Even with 20 % reduction in Q d total, the removal performance was also favorable.