Abstract
BackgroundOn-line hemodiafiltration (OL-HDF) has been generally provided mainly by the postdilution method in Europe and the rest of the world; however, in Japan, it has been provided mostly by the predilution method in order to ameliorate dialysis-related symptoms of dialysis patients by removing larger low molecular weight proteins. This study aimed to elucidate the removal properties of a newly launched asymmetric triacetate (ATA) membrane in OL-HDF both in the postdilution and predilution comparison with other synthetic polymer membranes.MethodsSix patients treated by OL-HDF at the Kawashima Hospital Group were randomly chosen for each membrane study. The removal properties of low molecular weight proteins were evaluated by β2-microglobulin (β2-MG), α1-microglobulin (α1-MG), albumin leakage, selective removal index of α1-MG for albumin, and transmembrane pressure for each treatment group. Two types of ATA membrane were evaluated in the study: FIX-S with mild protein permeability and FIX-U with higher protein permeability in the comparisons with other three types of synthetic polymer membranes.ResultsThe removal rate of β2-MG showed almost no significant differences between the postdilution and predilution methods in most membrane groups at around 75–80% without relations to the membrane material and the substitution volume.The removal rates of α1-MG were markedly different depending on the dilution method of HDF, the membranes, and the substitution volume. Generally, the removal rates of α1-MG were better in the postdilution than the predilution but the selective removals of α1-MG were better in the predilution. The high volume OL-HDF had the risk of excessive albumin leakage in a certain membrane choice.In the FIX series, the removal rates of α1-MG were sufficient both in the postdilution and predilution with the increase of the substitution volume with suppressing the albumin leakage during the dialysis session. Especially, FIX-U showed higher removal of α1-MG with suppressing the albumin leakage.ConclusionsThe newly launched ATA membrane could remove α1-MG, selectively suppressing the excessive albumin leakage and increasing the substitution volume safely even in high-volume postdilution.Trial registrationTrial registration: University hospital Medical Information Network (UMIN), UMIN 000035705. Registered 28 January 2019 - Retrospectively registered, https://www.umin.ac.jp/ctr/index-j.htm.
Highlights
On-line hemodiafiltration (OL-HDF) has been generally provided in the postdilution method in Europe and the rest of the world; it is quite different in Japan, where most of OL-HDF have been performed in the predilution method
The TDF group showed a slight increase in postdilution by the increase of substitution volume as 78.8 ± 5.1% for 12 L and 79.8 ± 5.1% for 16 L (p = 0.028)
High-volume postdilution OL-HDF has become one of the mainstreams in chronic dialysis based on the evidence of randomized control trials conducted mainly in Europe [1,2,3]; the membrane performances or solute removal properties have never discussed in these trials
Summary
On-line hemodiafiltration (OL-HDF) has been generally provided in the postdilution method in Europe and the rest of the world; it is quite different in Japan, where most of OL-HDF have been performed in the predilution method. The predilution method can freely increase the substitution volume even with a low blood flow rate and is able to improve the solute removal efficiency of low molecular weight proteins (LMWPs). The Japanese pioneer doctors found that dialysis prescriptions with larger LMWP removal incurring a certain level of albumin loss have improved various uremic symptoms. Based on these experiences, “protein permeable dialysis” has developed in Japan [5, 6]. On-line hemodiafiltration (OL-HDF) has been generally provided mainly by the postdilution method in Europe and the rest of the world; in Japan, it has been provided mostly by the predilution method in order to ameliorate dialysis-related symptoms of dialysis patients by removing larger low molecular weight proteins. This study aimed to elucidate the removal properties of a newly launched asymmetric triacetate (ATA) membrane in OL-HDF both in the postdilution and predilution comparison with other synthetic polymer membranes
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