Hemodiafiltration with Endogenous Reinfusion with and without Acetate-Free Dialysis Solutions: Effect on ESA Requirement
| Autor: | Piergiorgio Bolasco, M. Mascia, Stefano Murtas, F. Logias, B. Contu, M. Ganadu, Luca Corazza, F. Cadinu, Maria Laura Cossu, T. Ghisu, R. Ferrara, Paolo M. Ghezzi, Andrea Serra, D. Casu, M. Passaghe, G. Cogoni |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Treatment outcome Endogeny Hemodiafiltration Hemoglobins Dialysis solutions medicine Humans Erythropoietin Aged Uremia Aged 80 and over Chromatography integumentary system business.industry Vitamins Hematology General Medicine Middle Aged biochemical phenomena metabolism and nutrition equipment and supplies Hemodialysis Solutions Surgery carbohydrates (lipids) Treatment Outcome Multicenter study Nephrology Dietary Supplements Hematinics Cytokines bacteria Female business |
| Zdroj: | Blood Purification. 31:235-242 |
| ISSN: | 1421-9735 0253-5068 |
| DOI: | 10.1159/000322400 |
| Popis: | Background: Hemofiltrate reinfusion (HFR) is a form of hemodiafiltration (HDF) in which replacement fluid is constituted by ultrafiltrate from the patient ‘regenerated’ through a cartridge containing hydrophobic styrene resin. Bicarbonate-based dialysis solutions (DS) used in routine hemodialysis and HDF contain small quantities of acetate (3–5 mM) as a stabilizing agent, one of the major causes of intradialytic hypotension. Acetate-free (AF) DS have recently been made available, substituting acetate with hydrochloric acid. The impact of AF DS during HFR on Hb levels and erythropoietic-stimulating agent (ESA) requirement in chronic dialysis patients was assessed. Patients and Methods: After obtaining informed consent, 30 uremic patients treated by standard bicarbonate dialysis (BHD, DS with acetate) were randomized to treatment in 3-month cycles: first AF HFR, followed by HFR with acetate, and again AF HFR. At the beginning and end of each period, Hb and ESA requirements were evaluated. Results: A significant increase in the Hb level was observed throughout all periods of HFR versus BHD (from 11.1 to 11.86 g/dl; p = 0.04), with a significant decrease of ESA requirements from 29,500 to 25,033 IU/month (p = 0.04). Conclusion: Regardless of the presence or absence of acetate in DS, HFR per se allows a significant lowering of ESA dosage versus BHD, while at the same time increasing Hb levels. Taking for granted the clinical impact produced, HFR seems to provide a relevant decrease in end-stage renal disease patient costs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|