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Hemodiafiltration, biofeedback

Claudio Ronco
Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance...
2017: Contributions to Nephrology
Louise Chevalier, Christian Tielemans, Frederic Debelle, Dominique Vandervelde, Christine Fumeron, Lise Mandart, Jean-Claude Stolear, Isabelle Simon, Yahsou Delmas, Angelo Testa, Olivier Mat, Sophie Tezenas du Montcel, Lucile Mercadal
UNLABELLED: Dialysis biofeedback in hemodiafiltration with online regeneration of ultrafiltrate (HFR) could help to improve arterial hypertension. We evaluated the impact of isonatric HFR (HFR-iso) on hypertension control compared to conventional HFR. Forty-seven hemodialysis patients were included and randomized (ratio 2/1) HFR-iso versus HFR during 24 dialysis sessions. In the HFR-iso group (32 patients, 768 dialysis sessions), the predialytic systolic blood pressure (BP) decreased from S1 to S24 of 9 ± 20 mm Hg and increased of 5 ± 24 mm Hg in the HFR group (15 patients, 360 dialysis sessions), variation that differed between the 2 groups (x0394;S1-S24, p = 0...
2016: Blood Purification
Adrian Covic, Luminita Voroneanu
No abstract text is available yet for this article.
February 2013: Nephrology, Dialysis, Transplantation
Vincenzo Panichi, Giacomo De Ferrari, Stefano Saffioti, Antonino Sidoti, Marina Biagioli, Stefano Bianchi, Patrizio Imperiali, Claudio Gabbrielli, Paolo Conti, Pietro Patrone, Valeria Falqui, Giuseppe Rombolà, Carlo Mura, Andrea Icardi, Donatella Mulas, Alberto Rosati, Francesco Santori, Antonio Mannarino, Valeria Tomei, Andrea Bertucci, Denis Steckiph, Roberto Palla
BACKGROUND: Mixed diffusive-convective dialysis therapies offer greater removal capabilities than conventional dialysis. The aim of this study was to compare two different on-line, post-dilution hemodiafiltration (HDF) treatments with regard to achieved convective volume and middle-molecule dialysis efficiency: standard volume control (sOL-HDF) and automated control of the transmembrane pressure (TMP) (UC-HDF). METHODS: We enrolled 30 ESRD patients (55.9 ± 14.0 years, 20/10 M/F) in a randomized, prospective, cross-over study...
June 2012: International Journal of Artificial Organs
Francesco Locatelli, Sergio Stefoni, Thierry Petitclerc, Luigi Colì, Salvatore Di Filippo, Simeone Andrulli, Christine Fumeron, Giovanni Maria Frascà, Sibilla Sagripanti, Silvana Savoldi, Andrea Serra, Carmine Stallone, Filippo Aucella, Antonio Gesuete, Antonio Scarlatella, Francesco Quarello, Paola Mesiano, Peter Ahrenholz, Roland Winkler, Lise Mandart, Joan Fort, Christian Tielemans, Carlo Navino
BACKGROUND: Intradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH. METHODS: Fifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment...
October 2012: Nephrology, Dialysis, Transplantation
Lucile Mercadal, Céline Piékarski, Jean-Louis Renaux, Thierry Petitclerc, Gilbert Deray
Dialysate sodium prescription has major implications for hemodialysis tolerance but also for dialyzed patients' cardiovascular morbidity as a determinant factor of blood pressure. Biofeedback systems have been developed to drive dialysate conductivity in order to reach a prescribed serum sodium concentration, indirectly evaluated by a dialysate or an ultrafiltrate conductivity measurement. A biofeedback system using hemodiafiltration with online regeneration of ultrafiltrate (HFR) has been specially developed with an isonatric mode maintaining an equal serum sodium concentration between start and end of the dialysis session, combined with ultrafiltration and conductivity profiles...
November 2012: Journal of Nephrology
Lucile Mercadal, Thierry Petitclerc
Survival improvement of our haemodialysis patients is partly due to technologic improvement of the dialysis therapy. High permeability membranes and bicarbonate dialysate were the most relevant of past decades. What are the present technologic innovations that will provide clinical benefit? Acetate-free biofiltration, biofeedback systems, better haemodiafiltration techniques and techniques with adsorption could be part of them.
April 2009: Néphrologie & Thérapeutique
B Canaud
Online production of substitution fluid by 'cold sterilization' (ultrafiltration) of dialysis fluid gives access to virtually unlimited amounts of sterile and nonpyrogenic solution. The incorporation of the online hemodiafiltration (ol-HDF) module into the dialysis proportioning machine hardware simplifies the handling procedure, secures the process by keeping the safety regulation of the monitor and offers virtually unlimited amounts of sterile and nonpyrogenic substitutive solution. The safety of the ol-HDF relies upon use of ultrapure water and strict and permanent highly hygienic rules of use...
2007: Contributions to Nephrology
Luciano A Pedrini, Vincenzo De Cristofaro, Bruno Pagliari, Maria Filippini, Pio Ruggiero
No abstract text is available yet for this article.
2002: Contributions to Nephrology
R A Sherman
The dialysis prescription can have a substantial impact on the frequency of intradialytic hypotension (IDH). Plasma volume will decline to a greater extent when the ultrafiltration (UF) rate is rapid (high interdialytic weight gains and/or short treatment time), favoring IDH. The relationship of the target weight to the euvolemic weight determines the size of the interstitial fluid compartment, which is a major determinant of the rate of plasma refilling during UF. The higher the dialysate sodium, the smaller the decline in plasma volume for any given amount of UF...
October 2001: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
C Ronco, A Brendolan, M Milan, M P Rodeghiero, M Zanella, G La Greca
BACKGROUND: Hypotension is caused by a drop in blood volume during ultrafiltration, followed by vasoconstriction and reduced perfusion in some regions of the body. METHODS: We carried out a prospective controlled crossover study on 12 hypotension-prone patients with two different modalities: (A) acetate-free hemodiafiltration with standard ultrafiltration control, and (B) acetate-free hemodiafiltration with monitoring of blood volume and automatic biofeedback with machine-driven adjustments on ultrafiltration and dialysate conductivity...
August 2000: Kidney International
C Ronco, P M Ghezzi, G La Greca
The evolution of hemodialysis therapy has been characterized over the years by the search for reliable devices and supplies, for more efficient treatments and finally for a more tolerable therapy in long term dialysis patients. In this view, three steps can be identified: a) the first step was the creation of safe and reliable vascular access, dialyzers and machines. This step led to the birth of modern dialysis and treatment personalization was the logical consequence. Each patient is a single entity and he requires a specific therapy prescription and delivery...
July 1999: Journal of Nephrology
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