Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
Semin Dial. 2021 Sep;34(5):368-374. doi: 10.1111/sdi.12966. Epub 2021 Mar 28.
High-volume online hemodiafiltration (HDF) has been reported to reduce the patient's mortality. However, achieving a high convection volume is challenging. In this prospective study, we investigated the feasibility of achieving high-volume HDF with ≥21 L substitution volume via modification of blood flow rate (BFR), needle size, and dialysis membrane. In 30 patients undergoing hemodialysis, we followed a stepwise protocol and gradually increased the BFR (280→300→330 ml/min; steps 1, 2, and 3) and needle size (16→15 G; step 4). After changing dialyzer surface area (1.8 m →2.5 m ), the BFR and needle size were similarly increased stepwise (steps 5, 6, 7, and 8). The mean substitution volume was 18.7 ± 2.2 L at step 1 and it significantly increased to 25.1 ± 2.6 L by step 8. A substitution volume of 21 L was achieved by 13.3% of patients in step 1 and by 96.7% after step 8. The substitution volume was higher for the dialyzer with a large surface area and for the larger needle (15 G). Between steps 1 and 8, the Kt/V and β microglobulin reduction ratios also improved significantly. High-volume HDF is feasible through a stepwise increase in the BFR, needle size, and surface area of the dialysis membrane.
大容量在线血液透析滤过（HDF）已被报道可降低患者死亡率。然而，实现高对流量具有挑战性。在这项前瞻性研究中，我们通过改变血流速度（BFR）、针头大小和透析膜来研究通过修改达到高容量 HDF 的可行性，实现 ≥21L 的替代量。在 30 名接受血液透析的患者中，我们遵循逐步方案，逐渐增加 BFR（280→300→330ml/min；步骤 1、2 和 3）和针头大小（16→15G；步骤 4）。改变透析器表面积（1.8m→2.5m）后，BFR 和针头大小也同样逐步增加（步骤 5、6、7 和 8）。在步骤 1 时，平均替代量为 18.7±2.2L，在步骤 8 时显著增加至 25.1±2.6L。在步骤 1 中，有 13.3%的患者达到 21L 的替代量，在步骤 8 后达到 96.7%。大表面积透析器和较大针头（15G）的替代量更高。在步骤 1 和 8 之间，Kt/V 和β微球蛋白降低率也显著提高。通过逐步增加 BFR、针头大小和透析膜的表面积，可以实现高容量 HDF。
