Daily hemofiltration for end-stage renal disease: a feasibility and efficacy trial
| Autor: | John K. Leypoldt, Klemens B. Meyer, Geoffrey S. Teehan, Kevin D. Burns, Bertrand L. Jaber, Peter Swedko, Deborah Zimmerman |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Anemia medicine.medical_treatment Health Status Blood Pressure urologic and male genital diseases End stage renal disease Phosphates Quality of life Renal Dialysis Internal medicine Hemofiltration medicine Humans Urea Prospective Studies Intensive care medicine Dialysis Aged business.industry Hematology General Medicine Middle Aged medicine.disease Blood pressure Nephrology Creatinine Quality of Life Feasibility Studies Kidney Failure Chronic Calcium Female Hemodialysis business Energy Intake Kidney disease |
| Zdroj: | Blood purification. 22(6) |
| ISSN: | 0253-5068 |
| Popis: | Background: Although conventional hemodialysis (CHD) is currently provided primarily on an intermittent basis for patients with end-stage renal diseases (ESRD), the value of daily dialysis is well documented. Daily hemofiltration (DHF) is a convective therapy that has received little attention as an alternative to CHD. The aim of this feasibility study was to validate and assess the efficacy of DHF (6 times/week) as an alternative to CHD (3 times/week) in patients with ESRD. Methods: In this prospective single-arm open-labeled study, DHF was administered over 4 weeks after a 1-week run-in phase period of CHD. Blood samples were drawn at baseline and on a weekly basis during the trial, and ultrafiltrate samples were collected weekly during the DHF period. The primary endpoint was to achieve a daily spKt/V of 0.40 (equivalent to a weekly stdKt/V of ∼2.0). To achieve this goal, the DHF prescription consisted of an exchange volume of 40% of total body water. Secondary endpoints were the evaluation of blood pressure and anemia parameters, nutritional and mineral metabolism markers and health-related quality of life measures. Results: Twelve patients completed the study. Mean age was 54 years, two-thirds were men, and 83% had arteriovenous fistulae. DHF delivered a mean (±SD) spKt/V of 0.44 ± 0.06. This goal was reached by delivering an exchange volume of 13–14 liters, consisting of a replacement fluid volume of 11.7 ± 1.9 l/session and net fluid loss of 1.4 ± 0.1 l/session. Conversion from CHD to DHF resulted in marked reduction in treatment time (3.8 vs. 2 h/session, p < 0.001) and net fluid loss (2.6 vs. 1.4 l/session, p < 0.001). Calculated weekly standard Kt/V during the last week of DHF was 1.9 ± 0.2. DHF achieved a median β2-microglobulin (β2-M) removal of 170 mg/session, resulting in a decrease of mid-week pre-therapy β2-M levels (48 ± 34 vs. 36 ± 25 mg/l, p = 0.07). Compared with CHD, DHF resulted in lower systolic (143 ± 19 vs. 133 ± 16 mm Hg, p = 0.002) and diastolic (79 ± 11 vs. 72 ± 12 mm Hg, p = 0.002) blood pressure, reduction in antihypertensive medications (2.1 ± 0.7 vs. 1.1 ± 0.8, p = 0.002), higher caloric intake (1,778 ± 441 vs. 2,044 ± 564 kcal/day, p = 0.01), higher normalized protein catabolic rate (0.88 ± 0.17 vs. 1.00 ± 0.35 g/kg/day, p = 0.05), higher pre-albumin levels (330 ± 50 vs. 378 ± 84 g/dl, p = 0.06), higher vitality (p = 0.02), improved cognitive function (p = 0.04) and less symptoms/problems (p = 0.03). Serum albumin and potassium levels remained unchanged but the serum bicarbonate level dropped during the 1-month period of DHF. Conclusions: DHF (6 times/week) over a 1-month period achieved a weekly stdKt/V of ∼2.0, which is similar to that recommended for 3 times weekly CHD, reduced β2-M levels, lowered blood pressure, and had some beneficial effect on nutritional parameters, and health-related quality of life measures. |
| Databáze: | OpenAIRE |
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