Estudio comparativo entre dos formas de control del volumen de reinfusión y de la medición de la dosis de diálisis por dialisancia iónica en pacientes en hemodiafiltración on-line

Abstract

Introduction and objectivesKey elements in the best results that have been reported in on-line hemodiafiltration are the dialysis dose delivered and reinfusion volume. Technological advances allow two forms of automated control of reinfusion volume (a volume-based and a pressure-based control system), and two methods of measuring Kt obtained by ionic dialysance (OCM and Diascan). The purpose of this study was to compare both these control systems. MethodsWe designed a prospective, crossover study of the prevalent population in post-dilution on-line hemodiafiltration, with explicit consent. For 2 consecutive weeks, three sessions were performed with automatic reinfusion according to hematocrit and total protein values and Kt measurement with OCM, and three sessions were performed with automatic reinfusion according to transmembrane pressure and Kt measurement with Diascan. The average reinfusion volume and Kt were compared. Variables were contrasted with Student's t-test for related samples. Statistical significance was set at p <0.05. ResultsSixteen patients concluded the study (56% men, with a mean age of 58.8 years). A total of 81.3% had autologous or prosthetic fistulas for vascular access. Reinfusion volume was significantly higher (p=0.029) under pressure control (23.24±2.55 lversus 21.81±1.75 l) while Kt measured by OCM was significantly (p <0.001) higher than that measured by Diascan (59.94±5.05 l versus 55.12±4.15 l). ConclusionsWe found a 6.2% increase in volume reinfusion under pressure control, although both methods performed well in the final convective transport liters. The dialysis dose measured by Kt was higher when OCM was used.