S. David et al., PREDILUTION HEMOFILTRATION - CLINICAL-EXPERIENCE AND REMOVAL OF SMALLMOLECULAR-WEIGHT SOLUTES, International journal of artificial organs, 18(11), 1995, pp. 743-750
Over 1500 treatments of hemofiltration with on-line preparation of sub
stitution fluid were performed in 16 patients. Two patients were treat
ed for over 40 months. On-line preparation of the solution allowed use
of bicarbonate as a buffer. 73-74 L/session were infused in pre-dilut
ion modality, at a rate of about 370 ml/min, and the treatment length
was above 4 hrs. The good quality of on-line prepared solution was con
firmed by the negativity of microbiological tests and by the absence o
f clinical or sub-clinical reactions in patients. Urea clearance was c
alculated by equations considering either plasma flow or whole blood f
low. Results were 196-197 ml/min and 186-183 ml/min, respectively. The
latter was nearer to the value of directly measured clearance (182-17
3 ml/min). Kt/V urea was about 1 per session and PCR ranged between 1.
3 and 1.4 g/kg/day. A high Vascular stability was also observed. Since
sodium balance may, at least in part, account for better vascular sta
bility, sodium sieving coefficient was measured during the treatment.
The sodium-retaining effect of the increase of protein concentration w
ithin the filter, due to the ultrafiltration, was less relevant in pre
-dilution hemofiltration if compared to post-dilution hemofiltration.
It has been calculated that to obtain a sodium balance similar to that
of the hemodialysis (HD), the sodium concentration of infusion soluti
on should be about 2 mEq/L higher than HD dialysis solution. However,
difficulty in performing accurate balance studies prevents a general a
greement on these conclusions.