The Contribution of Hemofiltration among the Treatment Modalities of Chronic Uremia

Abstract

To assess the role of hemofiltration (HF) among different treatment modalities, we reviewed our clinical material from 37 patients that consecutively underwent the treatment from 1981 on. A number of 12 patients on HF for at least 1 year deliberately switched to hemodialysis (HD) or hemodiafiltration (HDF) were studied retrospectively. Biochemical and nutritional parameters, cardiovascular aspects and morbidity data were collected during one year before and after the treatment change. A sodium balance study was performed in 9 patients during HF as well. No significant differences in plasma urea, creatinine, phosphate, body weight, serum albumin, transferrin, hemoglobin and PCR were found. BUN tended to be lower during HD-HDF because of the more efficient removal of urea with these treatments. Indeed, the Kt/V index was 0.91 during HF and it was 1.15 with HD-HDF. There were no differences in hypotensive episodes and morbidity. Sodium loss was strictly related to body fluid removal during HF session with a net sodium loss (NSL) of 128 mEq per liter of fluid removal (FR) (NSL = 6.44 + 122 FR; r:0.83; p < 0.01). Adapting sodium concentration of substitution fluid to patients weight gain, cardiovascular stability improved in those subjects more prone to collapse. With equivalence in PCR during the 2 periods, although Kt/V was 20% lower during HF, it seems reasonable to assume that the lower urea clearance might be compensated by the more efficient removal of higher molecular weight substances and/or by the improved biocompatibility of HF.