Substitution-Free Hemodiafiltration

Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
ASAIO journal (American Society for Artificial Internal Organs: 1992) (Impact Factor: 1.52). 09/2012; 58(5):514-21. DOI: 10.1097/MAT.0b013e318260c5bb
Source: PubMed


Hemodiafiltration (HDF) has been reported to deliver better dialysis outcomes in patients with end-stage renal disease. Technical advances now allow online-based HDF to be used on a clinical basis. However, HDF is being performed at a limited rate because of the requirement of exogenous fluid infusion, which causes safety and cost issues. Therefore, various modifications on HDF strategies have been devised to achieve the HDF without exogenous fluid infusion, which can be achieved by spontaneous fluid reinfusion. In this article, substitution-free HDF strategies are reviewed in detail, with specific attention to technical aspects of the methodology, in vivo and in vitro efficacies, and applicability to clinical use.

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    ABSTRACT: The incidence of kidney disease is rapidly increasing worldwide, and techniques and devices for treating end-stage renal disease (ESRD) patients have been evolving. Better outcomes achieved by convective treatment have encouraged the use of synthetic membranes with high water permeability in clinical setups, and high-flux hemodialysis (HD) and hemodiafiltration (HDF) are now preferred forms of convective therapy in ESRD patients. Push/pull-based dialysis strategies have also been examined to increase convective mass transfer in ESRD patients. The push/pull technique uses the entire membrane as a forward filtration domain for a period of time. However, backfiltration must accompany the forward filtration to compensate for the fluid depletion resulting from the forward filtration, making it necessary to switch the membranes to a backfiltration domain. This paper attempts to describe the advancement of push/pull-based renal supportive treatments in terms of their technical description, hemodialytic efficacy including fluid management accuracy and applicability for clinical use. How the optimization of push and pull actions could translate into better convective efficiency will also be discussed in depth.
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