Marcelli Daniele, Kopperschmidt Pascal, Bayh Inga, Jirka Tomas, Merello Jose I, Ponce Pedro, Ladanyi Erzebeth, Di Benedetto Attilio, Dovc-Dimec Reina, Rosenberger Jaroslav, Stuard Stefano, Scholz Caecilia, Grassmann Aileen, Canaud Bernard
Fresenius Medical Care, Bad Homburg - Germany.
Int J Artif Organs. 2015 May;38(5):244-50. doi: 10.5301/ijao.5000414. Epub 2015 Jun 6.
The aim was to investigate factors associated with the successful achievement of ≥21 l/session of substitution fluid volume in patients on post-dilution hemodiafiltration.
3315 patients treated in 6 European countries with the Fresenius 5008 CorDiax machine including the AutoSub Plus feature were considered. Variables that showed a relationship with convection volume were entered in a multivariable logistic regression model.
Mean blood flow was 379 ± 68 ml/min. Median substitution volume was 24.7 L (IQR 22.0-27.4 L). Mean filtration fraction was 28.3 ± 4.1%. 81.5% of sessions qualified as high-volume HDF (substitution volumes ≥21 L). Higher age, dialyzer surface area, blood flow and treatment time were positively associated with the achievement of ≥21 L substitution volume; higher body mass index, male gender, higher hematocrit, graft or catheter vs. fistula, and start of week vs. mid-week were negatively associated.
Dialysis center policy in terms of blood flow, treatment time, filter size, and perhaps even hemoglobin targets plays a key role in achieving high-volume HDF. All of these are modifiable factors that can help in prescribing an optimal combination of dialyzer size, achievable blood flows, and treatment times.
