Influence of acetate-free biofiltration on intradialytic cardiovascular stability

Abstract

Background Acetate-free biofiltration (AFB) is a diffusive-convective dialysis procedure that utilizes a high-flux membrane (AN69), postdilution infusion of sodium bicarbonate solution, and a dialysate that is completely free of any buffer. The AFB technique may provide better cardiovascular stability and reduce intradialytic side effects. The aim of the present study was to investigate the influence of AFB, compared with bicarbonate dialysis (HD), on intradialytic cardiovascular stability and dialysis-induced morbidity. Patients and Methods The study included 5 patients with end-stage renal disease. Their mean age was 57.2 ± 1.6 years, and they had been undergoing hemodialysis (HD) for an average of 25 ± 22 months. The patients were followed for 1 year: they were treated first with HD for 6 months, followed by 6 months on AFB, maintaining all the dialytic parameters used during the HD. While the patients were on HD and AFB, we evaluated the number of episodes of intradialytic hypotension (IDH); the episodes of muscle cramps, nausea, headache (dialysis intolerance); dry body weight; and intradialysis weight loss. Data on dialysis adequacy and serum biochemistry were obtained monthly, and albumin and cholesterol were determined every 3 months. Results The results showed that after the switch from HD to AFB, there was a significant reduction in IDH (36.8% on HD, 13.5% on AFB; p<0.005) and in symptoms of dialysis intolerance (15.8% on HD, 2.8% on AFB; p<0.005). Intradialysis weight loss increased significantly on AFB (3.47 kg on HD, 3.63 kg on AFB; p<0.005), whereas dry body weight remained stable. Post-dialysis systolic blood pressure increased significantly on AFB (132.6 ± 7.7 mmHg on HD, 140.6 ± 5.4 mmHg on AFB; p<0.005). Post-dialysis diastolic blood pressure was also higher on AFB (76.9 ± 4.9 mmHg on HD, 81.8 ± 3.4 mmHg on AFB; p<0.005). The other parameters observed remained unchanged. Conclusion The percentage of dialysis sessions in which IDH and symptoms of dialysis intolerance occurred decreased significantly on AFB. AFB provided better control of dry body weight and post-dialysis systolic and diastolic blood pressure than did HD. These results show that AFB reduces intradialytic symptoms and improves patient quality of life.