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Removal of small and middle molecules by convective techniques

Removal of small and middle molecules by convective techniques Abstract The current renewed interest in haemofiltration (HF) is due mainly to its potential advantages in reducing morbidity and mortality. We analysed the data obtained from eight patients treated with pre‐dilution HF and compared them with the calculated post‐dilution HF and haemodialysis (HD) data in order to quantify the depurative performance of HF and to assess whether its claimed ability to improve cardiovascular stability is at least partially related to less sodium removal. The urea clearance (as a marker of small molecules) of pre‐dilution HF was equivalent to that of standard low‐flux HD and ∼20% higher than that of post‐dilution HF. For a calculated increase of 117% in the dialytic clearance of β2‐microglobulin using high‐flux HD, the increase in β2‐microglobulin removal with HF was only 30%. The intradialytic decrease in plasma water β2‐microglobulin concentrations was 73% (vs 53% in HD) followed by a post‐dialytic rebound of 85% (vs 42% in HD). The interdialytic concentrations of β2‐microglobulin were always lower. At the start of the subsequent session, the β2‐microglobulin concentrations observed in HF‐treated patients were 92% of those in the patients treated with HD. Sodium removal was similar using both HF modalities at the same total dialysate and reinfusate sodium concentrations, and lower than in the case of HD. HF makes it possible to obtain constantly lower plasma water β2‐microglobulin concentrations whose long‐term clinical relevance has to be verified. Under usual operational conditions, sodium removal is less with pre‐dilution HF than with HD, thus raising some doubts about the intrinsic capacity of HF to improve cardiovascular stability by a mechanism other than less sodium removal. convective techniques, haemofiltration, β2‐microglobulin, middle molecules, sodium balance, urea removal Correspondence and offprint requests to: Professor Francesco Locatelli, MD, Divisione di Nefrologia e Dialisi, Azienda Ospedale “A. Manzoni”, Via dell'Eremo 9–11, 23900 Lecco, Italy. © European Renal Association-European Dialysis and Transplant Association http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Nephrology Dialysis Transplantation Oxford University Press

Removal of small and middle molecules by convective techniques

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References (9)

Publisher
Oxford University Press
Copyright
© European Renal Association-European Dialysis and Transplant Association
ISSN
0931-0509
eISSN
1460-2385
DOI
10.1093/ndt/15.suppl_1.37
Publisher site
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Abstract

Abstract The current renewed interest in haemofiltration (HF) is due mainly to its potential advantages in reducing morbidity and mortality. We analysed the data obtained from eight patients treated with pre‐dilution HF and compared them with the calculated post‐dilution HF and haemodialysis (HD) data in order to quantify the depurative performance of HF and to assess whether its claimed ability to improve cardiovascular stability is at least partially related to less sodium removal. The urea clearance (as a marker of small molecules) of pre‐dilution HF was equivalent to that of standard low‐flux HD and ∼20% higher than that of post‐dilution HF. For a calculated increase of 117% in the dialytic clearance of β2‐microglobulin using high‐flux HD, the increase in β2‐microglobulin removal with HF was only 30%. The intradialytic decrease in plasma water β2‐microglobulin concentrations was 73% (vs 53% in HD) followed by a post‐dialytic rebound of 85% (vs 42% in HD). The interdialytic concentrations of β2‐microglobulin were always lower. At the start of the subsequent session, the β2‐microglobulin concentrations observed in HF‐treated patients were 92% of those in the patients treated with HD. Sodium removal was similar using both HF modalities at the same total dialysate and reinfusate sodium concentrations, and lower than in the case of HD. HF makes it possible to obtain constantly lower plasma water β2‐microglobulin concentrations whose long‐term clinical relevance has to be verified. Under usual operational conditions, sodium removal is less with pre‐dilution HF than with HD, thus raising some doubts about the intrinsic capacity of HF to improve cardiovascular stability by a mechanism other than less sodium removal. convective techniques, haemofiltration, β2‐microglobulin, middle molecules, sodium balance, urea removal Correspondence and offprint requests to: Professor Francesco Locatelli, MD, Divisione di Nefrologia e Dialisi, Azienda Ospedale “A. Manzoni”, Via dell'Eremo 9–11, 23900 Lecco, Italy. © European Renal Association-European Dialysis and Transplant Association

Journal

Nephrology Dialysis Transplantation – Oxford University Press

Published: Sep 1, 2000

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