Nephrology and Dialysis Unit, Ospedale 'Caduti Bollatesi', Bollate, Italy.
Blood Purif. 2011;31(4):259-67. doi: 10.1159/000321884. Epub 2011 Jan 14.
Postdilution hemodiafiltration (HDF) still remains the gold standard for solute removal, but with high hemoglobin levels transmembrane pressure (TMP) may reach high levels, reducing filter performance. We compared three online postdilution HDF treatments without TMP alarms for convective volume and plasma changes following treatment.
Twelve patients were enrolled in a trial with three online postdilution HDF treatments. In the volume-controlled mode (VOLc), we set the exchanged volume to obtain a filtration fraction close to 25% without TMP alarms. In the pressure-controlled mode (TMPc), we set the TMP at 100 mm Hg. In the ULTRAc mode (TMP scan combined with TMPc), the dialysis machine automatically selects the TMP with a scan. All treatments were performed with an AK200 ULTRA-S system.
Even with hemoglobin levels >12 g/dl, we found a 57% rise in ultrafiltration rate in TMPc versus VOLc and a 92% rise in ULTRAc versus VOLc. Phosphates and myoglobin levels were significantly affected by treatment type.
ULTRAc may be a useful tool to achieve an excellent purification performance without the constraints associated with the risk of hemoconcentration.
后稀释血液透析滤过（HDF）仍然是溶质清除的金标准，但血红蛋白水平较高时，跨膜压（TMP）可能达到较高水平，从而降低滤器性能。我们比较了三种在线后稀释 HDF 治疗方法，在不触发 TMP 报警的情况下，比较治疗前后的对流体积和血浆变化。
12 例患者参与了一项试验，分别接受三种在线后稀释 HDF 治疗。在容量控制模式（VOLc）下，我们设定了交换量，以获得接近 25%的滤过分数，且不触发 TMP 报警。在压力控制模式（TMPc）下，我们设定 TMP 为 100mmHg。在 ULTRAc 模式（TMP 扫描结合 TMPc）下，透析机会自动选择扫描的 TMP。所有治疗均在 AK200 ULTRA-S 系统上进行。
即使血红蛋白水平＞12g/dl，我们发现 TMPc 组的超滤率比 VOLc 组增加了 57%，而 ULTRAc 组比 VOLc 组增加了 92%。磷酸盐和肌红蛋白水平受治疗类型的显著影响。
ULTRAc 可能是一种有用的工具，可以在不增加血液浓缩风险相关限制的情况下，实现出色的净化性能。
