Hemodialysis Adequacy : A Review

Ankit N Metha MD, Andrew Z Fenves MD
Dialysis & Transplantation Vol 39 Issue 1, Pages 20-22, Jan 2010

Abstract


“Adequate dialysis” is interpreted as the amount of dialysis required to keep a patient alive and relatively asymptomatic. Since the inception of hemodialysis, there have been numerous approaches to quantify the delivered dialysis dose in a reproducible manner, and to link the dialysis dose with clinical outcomes.

Hemodialysis has been performed in some form for more than half a century. A description of Willem Kolff's dialyzer and of the first clinical dialysis was published back in 1944.1 Murray and collegues performed the first human hemodialysis in North America.2 At its inception, the dialysis prescription was empirically determined, and “adequate dialysis” was interpreted as the amount of dialysis required to keep the patient alive and relatively asymptomatic. Subsequently, there have been numerous approaches to quantify the delivered dialysis dose in a reproducible manner, and to link the dialysis dose with clinical outcomes.

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Effect of High-flux Versus Low-flux Dialysis Membranes on Parathyroid Hormone

Samuel H Makar,1 Happy K Sawires,1 Tarek M Farid,2 Waleed M Ali,3 Mona F Schaalan4

1Department of Pediatrics, Cairo University, Cairo, Egypt 2Department of Pediatrics, National Research Center, Cairo, Egypt 3Faculty of Science, Cairo University, Cairo, Egypt 4Department of Pharmacy, Misr International University, Cairo, Egypt

Iranian Journal of Kidney Diseases | Volume 4 | Number 4 | October 2010

Introduction. Hyperparathyroidism is a common finding in patients with renal insufficiency and parathyroid hormone (PTH) is considered a uremic toxin responsible for many of the abnormalities of the uremic state and bone disease. The aim of this study was to investigate the influence of permeability of low-flux versus high-flux dialysis membranes on intact PTH during hemodialysis in children.

Materials and Methods. Forty-four children aged between 4 and 13 years old on regular hemodialysis were enrolled in a prospective study. Low-flux polysulfone membranes were used for at least 6 months and then the patients were switched to use high-flux polysulfone membranes for 3 months. Serum electrolytes and intact PTH before and after dialysis were compared before and after changes in dialysis membrane.

Results. At the end of the 3-month use of high-flux filters, predialysis intact PTH level (49.40 ± 19.64 ng/dL) showed a highly significant decline (P < .001) compared to the predialysis intact PTH (21.67 ± 4.85 ng/dL) with low-flux membranes at the start of the study. Intact PTH level correlated negatively with serum ionized calcium and positively with serum phosphorus levels only in the predialysis samples with the use of low-flux but not high-flux filters. 


Conclusions. In children, high-flux dialysis membranes are more efficient in removal of intact PTH, one of the middle-sized uremic toxins, than low-flux membranes.

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Increasing dialysate flow rate increases dialyzer urea clearance and dialysis efficiency: An in vivo study

Ahmad Taher Azar
Misr University for Science and Technology, Systems and Biomedical

Engineering Department, 6th of October City, Egypt

Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2011 May 13];20:1023-9. Available from: http://www.sjkdt.org/text.asp?2009/20/6/1023/57258

Abstract

Clearance of urea depends on the dialysis solution flow rate as well. A faster dialysis solution flow rate increases the efficiency of diffusion of urea from blood to dialysate. An in vivo study was used in order to examine the effect of increasing dialysate flow rate (Q _D ) on dialyzer

urea clearance and dialysis efficiency expressed as Kt/V and URR. Group assignment was at the patient level rather than the facility level. The study subjects consisted of 138 hemodialysis patients on 3 times-per-week dialysis regimens. One way ANOVA test, Student's t test and Logistic regression analysis were used to analyze the data. Statistically significant increase in Kt/V and URR was noted as the dialysate flow increased from 500 to 800 mL/min when a moderate efficiency dialyzer with large surface area (1.6 m ² ) and high flux high efficiency dialyzers were used (P< 0.05). For moderate efficiency dialyzers with large surface area, Kt/V increased by 5.86% (P= 0.022628) and URR increased by 4.31% (P= 0.02263). 

Low efficiency and small surface area (1.2 m ² and 1.3 m ² ) dialyzer did not show an improvement in Kt/V or URR with increase in dialysate flow rate. Increasing Q _D from 500 to 800 mL/min is associated with a statistically significant increase in Kt/V, URR and dialyzer clearance in moderate efficiency low flux and high efficiency high flux dialyzers. Hemodialysis with Q _D of 800 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rates.

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Wishing all our 

Buddhist Brothers and Sisters

A Blessed & Sacred Wesak

(May the Blessing of The Triple Gems be on you)

Warmest Regards and Best Wishes

Malaysian KidneySPA

Al-Fatihah

Our Deepest and Heartfelf Condolences again to

the family of the late

Ahmad Sarbani Bin Mohamed

(A humble man with a great heart)

on his untimely demise

"May his soul be blessed and rest in peace"

We conclude our period of  mourning in his memory 

 A Friend and Comrade in Dialysis

Batch 25 (Seremban)

Effect of post-dilutional on-line haemodiafiltration on serum calcium, phosphate and parathyroid hormone concentrations in uraemic patients

Submitted by Mr CS Soong

Nephrol. Dial. Transplant. (2011) doi: 10.1093/ndt/gfr179 First published online: May 9, 2011

Ezio Movilli, Corrado Camerini, Paola Gaggia, Patrizia Poiatti, Alessandra Pola, Battista Fabio Viola, Roberto   Zubani, Guido Jeannin and Giovanni Cancarini

Author Affiliations Division of Nephrology, Spedali Civili and Section of Nephrology University of Brescia, Brescia, Italy

Correspondence and offprint requests to: Ezio Movilli; E-mail: eziomov@libero.it                                                                                          

Abstract

Background. Strict control of serum calcium and phosphate concentrations is paramount to prevent secondary hyperparathyroidism in haemodialysis (HD) patients. Standard intermittent low-flux HD (Lf-HD) is not sufficient to reach this goal. The aim of this study was to evaluate the effect of on-line haemodiafiltration (Ol-HDF) on serum calcium (sCa), phosphate (sPO4) and parathyroid hormone (PTHint) concentrations.

Methods. Of the 220 patients screened, 65 met the inclusion criteria for the study; 30 of whom agreed to participate in the study (Study group), the others were considered as the control group (Controls). Protocol for Study the group consisted of 6 months conventional Lf-HD (Period 1) and 6 months of post-dilutional Ol-HDF (Period 12). Controls continued their usual Lf-HD and were followed for 12 months. The main variables evaluated at the start and at the end of each period were sCa, sPO4 and PTHint.

Results. The switchover from Lf-HD to Ol-HDF resulted in a significant reduction of sPO4 (from 5.1 ¡¾ 1.0 to 4.0 ¡¾ | 0.7; P < 0.0001) and PTHint concentrations (from 307 ¡¾ 167 to 194 ¡¾ 98; P < 0.0001), no significant changes were found in both sCa concentrations (from 9.1 ¡¾ 0.7 to 8.9 ¡¾ 0.6) and phosphate binder dose. Kt/Vurea increased  significantly, and beta2 microglobulin concentrations decreased significantly. In the Controls, no significant variations of the same variables were observed over time, except for a significant increase in sevelamer intake.

Conclusion. This study supports the idea that Ol-HDF could be better than Lf-HD in controlling mineral metabolism  in HD patients.                                                                                                 

http://ndt.oxfordjournals.org/content/early/2011/05/08/ndt.gfr179.abstract?sid=af5f2e78-aa0e-4dbc-9138-06b0ae3cbeb|

Hepatitis C in hemodialysis patients needs more attention for control and review the risk factors Seyed-Moayed Alavian Professor of Gastroenterology and Hepatology, Baqiyatallah Research Center for Gastroenterology and Liver Diseases, P.O. Box 14155-3651, Tehran, Iran

Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2011 May 9];21:357-8. Available from: http://www.sjkdt.org/text.asp?2010/21/2/357/60213

We read with great interest the published article by Al-Jamal et al ^[1] about hepatitis C in fection (HCV) in hemodialysis patients in a region in Jordan. I agree with the authors about the importance of HCV infection in hemodia lysis patients, ^[2] but some points need clarifi cation. The prevalence of HCV infection among dialysis patients varies markedly from country to country and among dialysis centers within a single country. ^[3] The authors found the similar data, but it would have been better to discus more about the use of erythropoietin, universal precautions, health care services and number of nurses to the patients in the centers.

The results in the study confirm that duration of dialysis more than two years and number of transfusion as risk factors for higher preva lence of HCV compatible with other studies, ^[3],[4] however, the duration of hemodialysis may in directly reflect the number of blood transfu sions given, it was not clear if the time on hemodialysis was indeed an independent risk factor. Interestingly, 32% of their hemodialysis patients did not have history of blood trans fusion and evaluating this group separately would have been more informative in terms of duration or sessions per week as a direct risk factor for HCV.


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