Moving beyond small solute clearance: What evidence is there for more permeable dialyzers and haemodiafiltration?

AbstractDialyzers were initially developed for diffusive clearance of uraemic toxins. Diffusion most effectively clears small uncharged solutes from plasma water, such as urea. Sessional urea clearance targets have been shown to be important for short ‐term patient survival, but over the longer term, although low‐flux dialysis can prolong patient survival, accumulation of middle‐sized uraemic toxins, such as β2 microglobulin can lead to disabling arthropathy. Although the introduction of high‐flux dialyzers, designed to increase β2 micr oglobulin clearance, has reduced the prevalence of arthropathy; this has not been translated into a demonstrable significant improvement in patient survival. However, analysis of individual patients recruited into trials of haemo‐diafiltration reported that greater convective clearance was associa ted with better survival, although the individual trials reported mixed outcomes. Most haemodiafiltration trials were not designed to study the effect of convective dose, so although reported patient survival was greater for those receiving greater convective volume exchange, these results could pot entially be confounded by patient or center effects. An alternative approach to increasing middle‐sized solute clearances would be to use more permeable dialyzers, but as yet there are no trials reporting survival with larger cutoff dialyzers. As such, although there is increasing evidence that in creasing middle‐sized molecular ur...
Source: Hemodialysis International - Category: Hematology Authors: Tags: Review Article Source Type: research

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Purpose of review Pruritus is an important, prevalent but often neglected symptom in patients with advanced chronic kidney disease (CKD) or on dialysis. This review addresses the use of activated charcoal and its analogs in the treatment of uremic pruritus, which can be a sign of uremic toxicity. Recent findings When common causes are corrected and dialysis efficiency is optimized, pruritus is mainly ascribed to the retention of middle and protein-bound molecules, of which indoxyl sulfate and p-cresyl sulfate are the best studied. While hemodialysis and hemodiafiltration are of limited use, activated charcoal and its ...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: NOVEL THERAPEUTIC APPROACHES IN NEPHROLOGY AND HYPERTENSION: Edited by Kamyar Kalantar-Zadeh and Ekamol Tantisattamo Source Type: research
Publication date: Available online 28 November 2019Source: Journal of Membrane ScienceAuthor(s): Danilo Donato, Markus Storr, Bernd KrauseAbstractThe recent development of dialyzers equipped with medium cut-off membranes has made it possible to perform a new technique, termed expanded hemodialysis, in which the removal of middle molecular weight solutes from patients suffering from end-stage kidney disease is increased by enhanced internal filtration, without requiring complex setup and fluid reinfusion, as in hemodiafiltration. A systematic analysis of the effect of all dialyzer design parameters on the rate of internal f...
Source: Journal of Membrane Science - Category: Materials Science Source Type: research
Conclusion: Continuous hemodiafiltration is probably the best available modality of CRRT to treat hemodynamically unstable and critically ill patients of hepatic failure and/ or hepatorenal syndrome and it should be advocated more frequently. PMID: 31562715 [PubMed - in process]
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
The population undergoing haemodialysis continues to expand, with an increasing prevalence of elderly dependent patients including those aged>80 years. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of adequacy of dialysis, based on urea clearance, need to be broadened to encompass parameters including middle molecule clearance, salt and water balance, and patient symptoms and well-being. Haemodiafiltration provides improved middle molecule clearance over haemodialysis, with some evidence of improved survival.
Source: Medicine - Category: Internal Medicine Authors: Tags: Chronic kidney disease Source Type: research
Authors: Tapolyai M, Faludi M, Berta K, Forró M, Zsom L, Pethő ÁG, Rosivall L, Fülöp T Abstract Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative ...
Source: Renal Failure - Category: Urology & Nephrology Tags: Ren Fail Source Type: research
CONCLUSION: The increase of the surface area from 1.7 to 2.0 m2 in the MCO dialyzer has not meant a greater depurative effectiveness. In these dialyzers the increase of Qb does not seem to be as determinant as in hemodiafiltration except for the clearance of small molecules. PMID: 31104861 [PubMed - as supplied by publisher]
Source: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia - Category: Urology & Nephrology Tags: Nefrologia Source Type: research
Conclusions: CRRT achieves timely control of hypeammonemic states. Hemodynamic instability necessitating intervention with vasoactive medications is a common finding in patients with hyperammonemia.Blood Purif
Source: Blood Purification - Category: Hematology Source Type: research
Condition:   Chronic Kidney Disease Requiring Chronic Dialysis Intervention:   Device: on-line hemodiafiltration Sponsors:   Maimónides Biomedical Research Institute of Córdoba;   Instituto de Salud Carlos III Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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