TY - JOUR
AU - Bonomini, Mario
AB - INTRODUCTION: Home haemodialysis (HHD) is a dialysis modality offering the opportunity to individualize treatment to the patients’ needs and to deliver more treatment hours per week than in the center setting. However, despite the potential benefits, utilization of HHD remains quite low. Many reasons may account for this, primarily including the shortage of patient-friendly dialysis equipment for the home setting. We report our preliminary clinical experience with a new portable dialysis machine. METHODS: DIMI (Infomed, Geneva, Switzerland) is a device for homecare dialysis designed for a wide range of therapies including HD, HF, HDF, isolated ultrafiltration, and PD. The ease to use has largely been considered during the development of the system, which uses a PD-like small cartridge for all treatments, a heating bag included in the disposable, and a user interface simplified by using many pictograms. The cartridge drops into the cycler and contains all of the blood and fluid circuits; it can be supplied with/without a pre-attached high-flux dialyzer which physician can choose. Dialysis equipment employs a low-flow lactate or bicarbonate-buffered, ultrapure dialysate, supplied in premixed 5-l bags, without need for a reverse osmosis system. Beside therapy options, a wide array of operating ranges (time of the session; blood, ultrafiltration, dialysate/replacement fluid flow rates; volume of fluid) may allow a patient’s clinical needs to be met. Transport and installation of the device are facilitated by the foam box to which the machine is screwed, and no dedicated electrical circuit is required. Connection of DIMI to a web cloud is an integral part of the device, which can also run as stand alone without connection while treatment data remain recorded in the machine for a potential later download. DIMI device was used in nine prevalent ESRD patients (5 F, 4 M, aged 67.7±14.7 years). Patients were prescribed sessions of 2.5 hours with a lactate-based dialysate volume of 20 l, using a high-flux 1.7 m2 polyethersulfone haemodialyzer (Dimysis 017, Infomed). Procedures with the new device were executed in the center. Three patients used an arteriovenous fistula, and six a central venous catheter. In each patient, the urea reduction ratio ([urea pre dialysis - urea post-dialysis/urea pre-dialysis] x 100%; URR) and blood lactate levels (mmol/l, normal range 1-2 mmol/l) were determined. RESULTS: Extracorporeal sessions with the new device were well tolerated by all patients, who referred of a favorable warm feeling of body temperature. Ultrafiltration volume achieved was in accordance with prescription. The URR was 39.9±9.4 %. Blood lactate levels rose slightly after the dialysis session (from 1.47 mmol/l to 7.1±2.1 mmol/l) but returned to predialysis levels the day before. CONCLUSIONS: The prevalence of ESRD continues to grow internationally leading to a rise in need for renal replacement therapies. HHD has significant advantages over in—center dialysis but remains largely underutilized. The present data show that DIMI device is a promising new technology for many therapeutic applications in the homecare setting. Clinical studies are needed to define and confirm its optimal use, which may ultimately allow HHD to be considered in more patients. © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
TI - SP482A NEW PORTABLE DEVICE FOR HOME HAEMODIALYSIS
JF - Nephrology Dialysis Transplantation
DO - 10.1093/ndt/gfz103.sp482
DA - 2019-06-01
UR - https://www.deepdyve.com/lp/oxford-university-press/sp482a-new-portable-device-for-home-haemodialysis-uzmCMA0EN4
VL - 34
IS - Supplement_1
DP - DeepDyve
ER -