Achieving high convective volume in hemodiafiltration: Lessons learned after successful implementation in the HDFit trial.

Autor: Guedes M; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil., Dambiski AC; Irmandade da Santa Casa de Misericórdia de Curitiba, Curitiba, Paraná, Brazil., Canhada S; Fresenius Medical Care Brazil, Rio de Janeiro, Brazil., Barra ABL; Fresenius Medical Care Brazil, Rio de Janeiro, Brazil., Poli-de-Figueiredo CE; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil., Cuvello Neto AL; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil., Canziani MEF; Universidade Federal de São Paulo, São Paulo, Brazil., Strogoff-de-Matos JP; Clínica de Diálise Ingá, Rio de Janeiro, Brazil., Raimann JG; Renal Research Institute, New York, New York, USA., Larkin J; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.; Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany., Canaud B; Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany.; Montpellier University, Montpellier, France., Pecoits-Filho R; School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Jazyk: angličtina
Zdroj: Hemodialysis international. International Symposium on Home Hemodialysis [Hemodial Int] 2021 Jan; Vol. 25 (1), pp. 50-59. Date of Electronic Publication: 2020 Oct 15.
DOI: 10.1111/hdi.12891
Abstrakt: Background and Objectives: High-volume online hemodiafiltration (OL-HDF) associates with improved outcomes compared to hemodialysis (HD), provided adequate dosing is achieved as estimated from convective volume (CV). Achievement of high CV and its impact on biochemical indicators following a standardized protocol converting HD patients to OL-HDF has not been systematically reported. We assessed the success of implementation of OL-HDF in clinics naïve to the modality.
Design, Setting, Participants, and Measurements: We analyzed the results of the implementation of postdilution OL-HDF in patients randomized to the HDF arm of a clinical trial (impact of hemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFit) trial [ClinicalTrials.gov:NCT02787161]). The day before randomization of the first patient to OL-HDF at each clinic staff started a 3-day in-person training module on operation of Fresenius 5008 CorDiax machine in HDF mode. Patients were converted from high-flux HD to OL-HDF under oversight of trainers. OL-HDF was performed over a 6-months follow-up with a CV target of 22 L/treatment. We characterized median achieved CV >22 L/treatment record and analyzed the impact of HDF on biochemical variables.
Results: Ninety-seven patients (mean age 53 ± 16 years, 29% with diabetes, and 11% had a catheter) from 13 clinics randomized to the OL-HDF arm of the trial were converted from HD to HDF. Median CV > 22 L/treatment was achieved in 99% (94/95) of OL-HDF patients throughout follow-up. Monthly mean CV ranged from 27.1 L to 27.5 L. OL-HDF provided an increased single pool Kt/V at 3-months (0.2 [95% CI: 0.1-0.3]) and 6-months (0.2 [95% CI: 0.1-0.4]) compared to baseline, and reduced phosphate at 3-months (-0.4 mg/dL [95% CI: -0.8 to -0.12]) of follow-up.
Conclusions: High-volume online hemodiafiltration was successfully implemented with 99% of patients achieving protocol defined CV target. Monthly mean CV was consistently >22 L/treatment during follow-up. Kt/V increased, and phosphate decreased with OL-HDF. Findings resulting from a short training period in several dialysis facilities appear to suggest HDF is an easily implementable technique.
(© 2020 International Society for Hemodialysis.)
Databáze: MEDLINE
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