Nocturnal, every-other-day, online haemodiafiltration: an effective therapeutic alternative
| Autor: | Montserrat Elena, C.E. Durán, Aleix Cases, Nuria S. Pérez, Nayra Rico, Carola Arcal, Marta Arias, Alexis Sentís, Bergadá E, Néstor Fontseré, Josep M. Campistol, José Luis Bedini, Manel Vera, Néstor Rodríguez, Manel Azqueta, Francisco Maduell |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Nutritional Status Blood Pressure Hemodiafiltration Nocturnal Left ventricular hypertrophy Young Adult chemistry.chemical_compound Renal Dialysis medicine Humans Prospective Studies Blood urea nitrogen Dialysis Aged Transplantation Creatinine Cross-Over Studies business.industry Middle Aged Prognosis medicine.disease Crossover study Surgery Blood pressure chemistry Nephrology Anesthesia Female Hypertrophy Left Ventricular Kidney Diseases Hemodialysis business Biomarkers Follow-Up Studies |
| Zdroj: | Nephrology Dialysis Transplantation. 27:1619-1631 |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | Background. Longer and more frequent dialysis sessions have demonstrated excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. The aim of this study was to evaluate the beneficial effects of a longer (nocturnal) and more frequent (every-other-day) dialysis schedule with OL-HDF at the same or the highest convective volume. Methods. This prospective, in-centre crossover study was carried out in 26 patients, 18 males and 8 females, 49.2 6 14 years old, on 4–5 h thrice-weekly post-dilution OL-HDF, switched to nocturnal every-other-day OL-HDF. Patient inclusion criteria consisted of stable patients with good vascular access and with good prospects for improved occupational, psychological and social rehabilitation. Patients were randomly assigned into two groups: Group A received the same convective volume as previously for 6 months followed by a higher convective volume for a further 6 months, while Group B received the same schedule in reverse order. Results. Nocturnal every-other-day OL-HDF was well tolerated and 56% of patients who were working during the baseline period continued to work throughout the study with practically no absenteeism. The convective volume was 26.7 6 2 L at baseline, 27.5 6 2 with the unchanged volume and 42.9 6 4 L with the higher volume. eKt/V increased from 1.75 6 0.4 to 3.37 6 0.9. Bicarbonate, blood urea nitrogen (BUN) and creatinine values decreased, while phosphate levels fell markedly with a 90% reduction in phosphate binders. Blood pressure and left ventricular hypertrophy (LVH) improved and the use of anti-hypertensive drugs decreased. In both groups, BUN, creatinine and b2-microglobulin reduction ratios improved. Different removal patterns were observed for myoglobin, prolactin and a1-acid glycoprotein. Conclusions. Nocturnal every-other-day OL-HDF could be an excellent therapeutic alternative since good tolerance and occupational rehabilitation, marked improvement in dialysis dose, nutritional status, LVH, phosphate and hypertension control and a substantial reduction in drug requirements were observed. In this crossover study, different removal patterns of large solutes were identified. |
| Databáze: | OpenAIRE |
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