부산대학교 도서관

Background Post-dilution haemodiafiltration (post-HDF) is highly efficient in terms of solute clearance but haemoconcentration and dialysis circuit clotting potentially inhibit its clinical application. Objectives Mixed-dilution HDF (mixed-HDF), developed to permit simultaneous pre- and post-fluid delivery, has been proposed to deliver higher total convection volumes and other associated benefits. We explored potential benefits of mixed-HDF. Design/participants In this prospective, open label, randomised, cross-over study, patients were randomised to receive, after a 2-week wash-in period of control therapy (post-HDF), 4 weeks of the control therapy (post-HDF) first (intervention period 1), followed by a 2-week wash-out period, and then 4 weeks of experimental therapy (mixed-HDF) (intervention period 2), or vice versa. Measurements The primary outcome was total convention volume. Secondary outcomes were differences in transmembrane pressures (TMP), circuit clotting, small and middle molecule clearances and post-dialysis recovery times. Results A total of 25 patients were recruited from two Australian dialysis centres, with 22 patients completing the study (mean age 62.5 years, 63.6% male, 36.4% diabetes). Total convection volumes were significantly higher with mixed-HDF (39.0L) compared to post-HDF (21.9L; difference 17.5L, 95% CI 15.47-18.64L, p Conclusion Convection volumes significantly increased with mixed-HDF but solute clearances and post-dialysis recovery times were not different to post-HDF. Longer studies will be required to determine whether the higher convention volume results in clinically significant improvements in outcomes. Keywords dialysis, haemodiafiltration, mixed-HDF, recovery, convection
Introduction Chronic kidney disease is increasing in incidence and many patients in Australia and New Zealand require kidney replacement therapy (KRT). Haemodialysis (HD) is the most common type of KRT [...]