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Effective removal of protein-bound uraemic solutes by different convective strategies: a prospective trial

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Abstract
Background. Although different on-line convective removal strategies are available, there are no studies comparing the efficiency of solute removal for the three main options [post-dilution haemodiafiltration (post-HDF), pre-dilution haemodiafiltration (pre-HDF) and pre-dilution haemofiltration (pre-HF)] in parallel. Methods. In this study, we compared post-HDF (Polyflux 170), pre-HDF (Polyflux 170) and pre-HF (Polyflux 210) in 14 patients. Parallelism of the evaluation protocols consisted in applying the same blood flow, dialysis time and effective convection (22.9 +/- 1.7 versus 22.2 +/- 2.0 L, P = NS) in pre-HDF versus post-HDF, and the same blood flow and dialysis time while comparing pre-HDF and pre-HF (1:1 dilution). With pre-HF, ultrafiltration was maximized and resulted in an effective convective volume of 28.5 L. We studied water-soluble compounds (urea, creatinine, uric acid), protein-bound compounds (hippuric acid, indole acetic acid, indoxylsulfate and p-cresylsulfate) and beta(2)-microglobulin (beta M-2). Results. Post-HDF was superior to pre-HDF for water-soluble compounds and beta M-2, whereas there was no difference for protein-bound compounds. Pre-HDF was superior to pre-HF for water-soluble compounds and protein-bound compounds. In contrast, removal of beta M-2 for pre-HF was higher than for pre-HDF, but it did not differ from that obtained with post-HDF. Conclusions. It is concluded that post-dilution is superior to pre-dilution HDF under conditions of similar convective volume, and that HDF is superior to HF in pre-dilution, with the exception of removal of beta M-2. Overall, post-HDF is the most efficient convective strategy among those tested.
Keywords
MAINTENANCE HEMODIALYSIS, PERITONEAL-DIALYSIS, DIALYZER MEMBRANE, P-CRESOL, ONLINE HEMODIAFILTRATION, HIGH-FLUX HEMODIALYSIS, PATIENTS RECEIVING HEMODIAFILTRATION, MIDDLE MOLECULES, INDOXYL SULFATE, MORTALITY RISK

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Chicago
Meert, Natalie, Sunny Eloot, MARIA WATERLOOS, Maria Van Landschoot, Annemieke Dhondt, Griet Glorieux, Ingrid Ledebo, and Raymond Vanholder. 2009. “Effective Removal of Protein-bound Uraemic Solutes by Different Convective Strategies: a Prospective Trial.” Nephrology Dialysis Transplantation 24 (2): 562–570.
APA
Meert, N., Eloot, S., WATERLOOS, M., Van Landschoot, M., Dhondt, A., Glorieux, G., Ledebo, I., et al. (2009). Effective removal of protein-bound uraemic solutes by different convective strategies: a prospective trial. NEPHROLOGY DIALYSIS TRANSPLANTATION, 24(2), 562–570.
Vancouver
1.
Meert N, Eloot S, WATERLOOS M, Van Landschoot M, Dhondt A, Glorieux G, et al. Effective removal of protein-bound uraemic solutes by different convective strategies: a prospective trial. NEPHROLOGY DIALYSIS TRANSPLANTATION. OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND; 2009;24(2):562–70.
MLA
Meert, Natalie, Sunny Eloot, MARIA WATERLOOS, et al. “Effective Removal of Protein-bound Uraemic Solutes by Different Convective Strategies: a Prospective Trial.” NEPHROLOGY DIALYSIS TRANSPLANTATION 24.2 (2009): 562–570. Print.
@article{519423,
  abstract     = {Background. Although different on-line convective removal strategies are available, there are no studies comparing the efficiency of solute removal for the three main options [post-dilution haemodiafiltration (post-HDF), pre-dilution haemodiafiltration (pre-HDF) and pre-dilution haemofiltration (pre-HF)] in parallel.
Methods. In this study, we compared post-HDF (Polyflux 170), pre-HDF (Polyflux 170) and pre-HF (Polyflux 210) in 14 patients. Parallelism of the evaluation protocols consisted in applying the same blood flow, dialysis time and effective convection (22.9 +/- 1.7 versus 22.2 +/- 2.0 L, P = NS) in pre-HDF versus post-HDF, and the same blood flow and dialysis time while comparing pre-HDF and pre-HF (1:1 dilution). With pre-HF, ultrafiltration was maximized and resulted in an effective convective volume of 28.5 L. We studied water-soluble compounds (urea, creatinine, uric acid), protein-bound compounds (hippuric acid, indole acetic acid, indoxylsulfate and p-cresylsulfate) and beta(2)-microglobulin (beta M-2).

Results. Post-HDF was superior to pre-HDF for water-soluble compounds and beta M-2, whereas there was no difference for protein-bound compounds. Pre-HDF was superior to pre-HF for water-soluble compounds and protein-bound compounds. In contrast, removal of beta M-2 for pre-HF was higher than for pre-HDF, but it did not differ from that obtained with post-HDF.

Conclusions. It is concluded that post-dilution is superior to pre-dilution HDF under conditions of similar convective volume, and that HDF is superior to HF in pre-dilution, with the exception of removal of beta M-2. Overall, post-HDF is the most efficient convective strategy among those tested.},
  author       = {Meert, Natalie and Eloot, Sunny and WATERLOOS, MARIA and Van Landschoot, Maria and Dhondt, Annemieke and Glorieux, Griet and Ledebo, Ingrid and Vanholder, Raymond},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  language     = {eng},
  number       = {2},
  pages        = {562--570},
  publisher    = {OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND},
  title        = {Effective removal of protein-bound uraemic solutes by different convective strategies: a prospective trial},
  url          = {http://dx.doi.org/10.1093/ndt/gfn522},
  volume       = {24},
  year         = {2009},
}

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