Measurement of the effective dialyzer Na diffusion gradient in vitro and in vivo

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    ABSTRACT: A computer model was developed to simulate sodium and water kinetics during hemodiafiltration (HDF), acetate-free biofiltration (AFB) and hemodialysis (HD). Multiple regression analysis of the results of 3,240 simulated applications of the model (1,620 HDF, 1,080 AFB, 540 HD) showed that, during HDF and AFB, there is a close correlation (R2 = 0.92 and 0.91) between plasma water sodium concentration [( Na+P]) and a set of three variables: 1) the sodium gradient between plasma water and dialysate, 2) the sodium concentration of the substitution fluid and 3) ultrafiltration (UF) rate. With HD, a close correlation (R2 = 0.94) was found between changes in [Na+P] and combined changes in sodium gradient and the UF rate. On this basis, a regression equation was formulated for each procedure which allowed a reliable prediction of final [Na+P] to be made on the basis of knowledge of the imposed Na gradient, the programmed infusion (during HDF and AFB), and the UF rate. Clinical validation of the model was obtained in 12 patients: predicted final [Na+P] agreed well with the values measured by means of direct potentiometry (141.9 vs. 142.1 mEq/liter; P = NS), with a mean difference (-0.16 mEq/liter) and limits of agreement (+0.8 to -1.03 mEq/liter) fully acceptable for clinical purposes.(ABSTRACT TRUNCATED AT 250 WORDS)
    Kidney International 10/1991; 40(3):525-32. DOI:10.1038/ki.1991.241 · 8.56 Impact Factor
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    ABSTRACT: Some of the morbidity associated with chronic hemodialysis is thought to result from retention of large molecular weight solutes that are poorly removed by diffusion in conventional hemodialysis. Hemodiafiltration combines convective and diffusive solute removal in a single therapy. The hypothesis that hemodiafiltration provides better solute removal than high-flux hemodialysis was tested in a prospective, randomized clinical trial. Patients were randomized to either on-line postdilution hemodiafiltration or high-flux hemodialysis. The groups did not differ in body size, treatment time, blood flow rate, or net fluid removal. The filtration volume in hemodiafiltration was 21 +/-1 L. Therapy prescriptions were unchanged for a 12-mo study period. Removal of both small (urea and creatinine) and large (ss(2)-microglobulin and complement factor D) solutes was significantly greater for hemodiafiltration than for high-flux hemodialysis. The increased urea and creatinine removal did not result in lower pretreatment serum concentrations in the hemodiafiltration group. Pretreatment plasma beta(2)-microglobulin concentrations decreased with time (P< 0.001); however, the decrease was similar for both therapies (P = 0.317). Pretreatment plasma complement factor D concentrations also decreased with time (P<0.001), and the decrease was significantly greater with hemodiafiltration than with high-flux hemodialysis (P = 0.010). The conclusion is that on-line hemodiafiltration provides superior solute removal to high-flux hemodialysis over a wide molecular weight range. The improved removal may not result in lower pretreatment plasma concentrations, however, possibly because of limitations in mass transfer rates within the body.
    Journal of the American Society of Nephrology 12/2000; 11(12):2344-50. · 9.34 Impact Factor
  • Seminars in Dialysis 01/2002; 12(1):S‐41 - S‐44. DOI:10.1046/j.1525-139X.1999.90203.x · 1.75 Impact Factor
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