Hemodiafiltration: Technical and Clinical Issues

Blood Purification
C Ronco

Abstract

Hemodiafiltration (HDF) seems to represent the gold standard in the field of replacement of renal function by dialysis. High convective fluxes have been correlated with better clinical outcomes. Sometimes, however, there are technical barriers to the achievement of high blood flows adequate to perform effective convective therapies. In spite of optimized procedures, the progressive increase in transmembrane pressure (TMP), the blood viscosity due to hemoconcentration and blood path resistance sometimes becomes inevitable. We propose two possible solutions that can be operated automatically via specific software in the dialysis machine: predilution on demand and backflush on demand. Predilution on demand consists in an automatic feedback of the machine, diverting part of the filtered dialysate into a predilution mode with an infusion of 200 ml in 30 s while the ultrafiltration pump stops. This produces a sudden hemodilution with a return of the parameters to acceptable values. The performance of the filter improves, and the pressure alterations are mitigated. Backflush on demand consists in an automatic feedback of the machine triggered by the TMP control, producing a positive pressure in the dialysate compartment due to a stop ...Continue Reading

Citations

May 10, 2017·Blood Purification·Claudio Ronco
Oct 4, 2018·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Claudio RoncoArmando J Martínez Rueda
Apr 10, 2019·Polymers·Marina VoinovaLeonid Gorelik
May 8, 2018·Nature Reviews. Nephrology·Claudio Ronco, William R Clark
Jan 7, 2019·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Fabio PaglialongaEnrico Verrina
Jan 7, 2021·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Juan G ArizaJasmin I Vesga

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