Intradialytic glucose infusion increases polysulphone membrane permeability and post-dilutional haemodiafiltration performances

Introduction. During real-time monitoring of the ultrafiltration coefficien t (Kuf) in haemodiafiltration (HDF), it was noticed that the ultrafiltratio n performance of polysulphone membrane dialysers increased when hypertonic glucose (D50%) was administered through the venous blood return. Methods. This observation was explored in six non-diabetic chronic dialysis patients during 48 HDF sessions using 1.8 m(2) polysulphone membrane dialy sers. In all six patients, 24 sessions were performed with glucose suppleme ntation (as a continuous D50% (500 g/l) infusion at 40 ml/h) and 24 session s without supplementation. Results. Glucose supplementation led to a marked increase in Kuf from 22.8/-2.2 (without D50%, n=24) to 32.1+/-3.9 ml/h/mmHg (with D50%, n=24) (P<0.0 001). An increase in percentage reduction ratios for urea and creatinine we re also consistently observed during the sessions with glucose administrati on (from respective mean values of 75+/-5 and 68+/-4% to 79+/-4 and 74+/-10 %). Mean double-pool Kt/V, calculated from serum urea concentrations, rose from 1.65+/-0.24 (n=24) to 1.86+/-0.24 (n=24) (P<0.005). Similar results we re observed in a subgroup of 18 HDF sessions (nine with glucose and nine wi thout) monitored with an on-line urea sensor of spent dialysate. No detrime ntal effects were induced at any time. Conclusions. We conclude that intravenous glucose administration during hig h-flux HDF using polysulphone membranes increases significantly both ultraf iltration capacity and dialysis dose delivery.