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Hemodiafiltration

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Dr Anupma Kaul, Lucknow    27 December 2018

  • Basics of hemodiafiltration (HDF): Transfer of solute across the membrane - Sieving coefficient, membrane characteristic, molecular weight, bound fraction, tissue distribution; Convective clearance for a given solute - Total ultrafiltered volume + solute sieving coefficient for the membrane; The total ultrafiltered volume - Fluid removal + Replacement volume infused during the treatment enhancing convection.
  • Possible advantages of HDF: Clearance of uremic solutes across a wide molecular weight range; biocompatibility; hemodynamic stability.
  • Issues with HDF: Risk of potential adverse effects of bacterial-derived products entering the blood stream; High albumin loss; Deficiency syndromes: Enhanced loss of nutrients, soluble vitamins, trace elements, amino acids, small peptides and proteins.
  • Analysis of current HDF practices: Do not support the notion that HDF is a superior treatment in comparison with HD, in reducing all-cause and CV mortality.
  • Evidence supporting a dose response relationship between the magnitude of the convection volume and mortality risk - (>23 L/session, i.e., 69 L/week): Larger the convection volume, better the outcome. Possible benefit on patient outcome needs validation. There are no clear side effects and no clear safety issues.

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