{"id":2783,"date":"2020-03-24T19:21:12","date_gmt":"2020-03-25T00:21:12","guid":{"rendered":"https:\/\/staging.advancedrenaleducation.com\/wparep\/?post_type=article&p=1142"},"modified":"2025-05-22T13:12:52","modified_gmt":"2025-05-22T18:12:52","slug":"increased-frequency-other-modalities","status":"publish","type":"article","link":"https:\/\/staging.advancedrenaleducation.com\/wparep\/asiapacific\/article\/increased-frequency-other-modalities\/","title":{"rendered":"Increased Frequency \u2013 Other Modalities"},"content":{"rendered":"

Although most reports of increased frequency regimens describe HD (both low and high flux) other dialysis modalities such as hemofiltration and hemodiafiltration have also been used.\u00a0 Maduell et al. recently reported the experience of 8 patients converted from standard thrice weekly 4-hours on-line hemodiafiltration (stdHDF) to daily HDF (DHDF) 2-2.5 hours 6 times weekly1<\/sup>. \u00a0The patients were followed up for 6 months. \u00a0Significant increases in weekly removal for large molecules (up to 23 kD) were reported but a consistent reduction in concentration was only identified for \u03b22-microglobulin. \u00a0No changes were identified for hemoglobin, EPO dose, serum lipids. \u00a0There was an insignificant trend for lowering of C-reactive protein and fibrinogen. \u00a0Despite unchanged BP, DHDF was associated with a large reduction in LVMI (97.9 \u00b1 45 to 68.9 \u00b1 22 g\/m2<\/sup>).<\/p>\n

\"\"<\/a>Significant increase in the weekly percentage removal of solutes with daily HDF.\u00a0 Based on reference 1.<\/h6>\n

Fishbach et al. reported conversion of 5 unstable children with impaired cardiac function from stdHDF (4 hours thrice weekly) to DHDF (3 hours 6 times weekly)2<\/sup>. \u00a0The results were encouraging. \u00a0Anemia improved with a lower EPO dose. \u00a0Serum phosphate and the calcium-phosphorus product fell, as did serum \u03b22-microglobulin and homocysteine.\u00a0 In addition, significant improvements were seen for control of BP and in cardiac function. \u00a0Catch-up growth occurred in one patient with severe growth retardation.<\/p>\n

Daily hemofiltration can be applied using an on-line system or a system where replacement fluid is provided in PVC bags.\u00a0 There are theoretical issues regarding adequacy of small solute removal with hemofiltration, particularly where practiced in a short daily regimen. As yet, there is inadequate clinical information to assess this modality.<\/p>\n

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References:<\/h4>\n
    \n
  1. Maduell F, Navarro V, Torregrosa E, Rius A, Dicenta F, Cruz MC, Ferrero A.\u00a0 Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration. Kidney Int<\/i> 64:305-313, 2003<\/li>\n
  2. Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A.\u00a0 Daily on-line haemodiafiltration: a pilot trial in children.\u00a0 Nephrol Dial Transplant<\/i> 19:2360-2367, 2004<\/li>\n<\/ol>\n
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