Abstract
PurposeTo 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 (Qdtotal).MethodsSubjects were 8 patients undergoing pre-HDF. Study 1: Post-HDF was performed at a blood flow rate (Qb) 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, Qdtotal of 500 and Qb of 250 mL/min; G-2, Qdtotal of 400 and Qb of 250 mL/min; and G-3, Qdtotal of 400 and Qb of 300 mL/min. Removal efficiency was compared and analyzed between these conditions.ResultsStudy 1: The results using FIX, ABH and NVF are shown in order. The Kt/V were 1.8, 1.9 and 1.8. The β2-Microglobulin (MG) removal rate (RR) (%) were 81.2, 83.1 and 82.8, and the α1-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 β2-MG RR (%) were 81.2, 80.1 and 81.0, and the α1-MG RR were 37.4, 37.5 and 38.0, respectively.ConclusionsLow-volume post-HDF performed at Qb of 250 mL/min with Japanese high-performance hemodiafilters exhibited favorable removal efficiency for all solutes. Even with 20 % reduction in Qdtotal, the removal performance was also favorable.
Highlights
At the end of 2017, in Japan, there were 334,505 dialysis patients, 21.1 % of whom were receiving online (OL) hemodiafiltration (HDF)
We reported that post-HDF using recent high-performance hemodiafilter efficiently removed low-molecular-weight protein (LMWP), caused only mild Alb loss, and was comparable with pre-HDF in terms of biocompatibility [6]
During post-HDF, the increase in transmembrane pressure (TMP) was mild for all hemodiafilters, and it remained at 100 mmHg or lower until the end of each session
Summary
At the end of 2017, in Japan, there were 334,505 dialysis patients, 21.1 % of whom were receiving online (OL) hemodiafiltration (HDF). We previously reported that pre-HDF was superior to post-HDF in terms of biocompatibility [5]. We reported that post-HDF using recent high-performance hemodiafilter efficiently removed low-molecular-weight protein (LMWP), caused only mild Alb loss, and was comparable with pre-HDF in terms of biocompatibility [6]. In Study 1 of the present study, post-HDF was performed with 3 types of Japanese high-performance hemodiafilters at Vs of 12 L/session (s) and Qb of 250 mL/min, and the removal performance was assessed. We examined whether this low-volume post-HDF with moderate Qb exhibited removal efficiency adequate for HDF. In Study 2, removal performance of post-HDF with fixed Vs of 12 L/s and 20 % reduction in the total dialysate flow rate (Qdtotal) was assessed to examine whether the dialysate volume could be reduced
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