Achieving high convection volumes in postdilution online hemodiafiltration: a prospective multicenter study

Camiel L M de Roij van Zuijdewijn, Isabelle Chapdelaine, Menso J Nubé, Peter J Blankestijn, Michiel L Bots, Constantijn J A M Konings, Ton K Kremer Hovinga, Femke M Molenaar, Neelke C van der Weerd, Muriel P C Grooteman

Research output: Contribution to journalArticleProfessional

Abstract

Background. Available evidence suggests a reduced mortality risk for patients treated with high-volume postdilution hemodiafiltration (HDF) when compared with hemodialysis (HD) patients. As the magnitude of the convection volume depends on treatment-related factors rather than patient-related characteristics, we prospectively investigated whether a high convection volume (defined as ≥22 L/session) is feasible in the majority of patients (>75%). Methods. A multicenter study was performed in adult prevalent dialysis patients. Nonparticipating eligible patients formed the control group. Using a stepwise protocol, treatment time (up to 4 hours), blood flow rate (up to 400 mL/min) and filtration fraction (up to 33%) were optimized as much as possible. The convection volume was determined at the end of this optimization phase and at 4 and 8 weeks thereafter. Results. Baseline characteristics were comparable in participants (n = 86) and controls (n = 58). At the end of the optimization and 8 weeks thereafter, 71/86 (83%) and 66/83 (80%) of the patients achieved high-volume HDF (mean 25.5 ± 3.6 and 26.0 ± 3.4 L/session, respectively). While treatment time remained unaltered, mean blood flow rate increased by 27% and filtration fraction increased by 23%. Patients with <22 L/session had a higher percentage of central venous catheters (CVCs), a shorter treatment time and lower blood flow rate when compared with patients with ≥22 L/session. Conclusions. High-volume HDF is feasible in a clear majority of dialysis patients. Since none of the patients agreed to increase treatment time, these findings indicate that high-volume HDF is feasible just by increasing blood flow rate and filtration fraction.

Original languageEnglish
Pages (from-to)804-812
Number of pages9
JournalClinical kidney journal
Volume10
Issue number6
DOIs
Publication statusPublished - Dec 2017

Cite this

de Roij van Zuijdewijn, Camiel L M ; Chapdelaine, Isabelle ; Nubé, Menso J ; Blankestijn, Peter J ; Bots, Michiel L ; Konings, Constantijn J A M ; Kremer Hovinga, Ton K ; Molenaar, Femke M ; van der Weerd, Neelke C ; Grooteman, Muriel P C. / Achieving high convection volumes in postdilution online hemodiafiltration : a prospective multicenter study. In: Clinical kidney journal. 2017 ; Vol. 10, No. 6. pp. 804-812.
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title = "Achieving high convection volumes in postdilution online hemodiafiltration: a prospective multicenter study",
abstract = "Background. Available evidence suggests a reduced mortality risk for patients treated with high-volume postdilution hemodiafiltration (HDF) when compared with hemodialysis (HD) patients. As the magnitude of the convection volume depends on treatment-related factors rather than patient-related characteristics, we prospectively investigated whether a high convection volume (defined as ≥22 L/session) is feasible in the majority of patients (>75{\%}). Methods. A multicenter study was performed in adult prevalent dialysis patients. Nonparticipating eligible patients formed the control group. Using a stepwise protocol, treatment time (up to 4 hours), blood flow rate (up to 400 mL/min) and filtration fraction (up to 33{\%}) were optimized as much as possible. The convection volume was determined at the end of this optimization phase and at 4 and 8 weeks thereafter. Results. Baseline characteristics were comparable in participants (n = 86) and controls (n = 58). At the end of the optimization and 8 weeks thereafter, 71/86 (83{\%}) and 66/83 (80{\%}) of the patients achieved high-volume HDF (mean 25.5 ± 3.6 and 26.0 ± 3.4 L/session, respectively). While treatment time remained unaltered, mean blood flow rate increased by 27{\%} and filtration fraction increased by 23{\%}. Patients with <22 L/session had a higher percentage of central venous catheters (CVCs), a shorter treatment time and lower blood flow rate when compared with patients with ≥22 L/session. Conclusions. High-volume HDF is feasible in a clear majority of dialysis patients. Since none of the patients agreed to increase treatment time, these findings indicate that high-volume HDF is feasible just by increasing blood flow rate and filtration fraction.",
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author = "{de Roij van Zuijdewijn}, {Camiel L M} and Isabelle Chapdelaine and Nub{\'e}, {Menso J} and Blankestijn, {Peter J} and Bots, {Michiel L} and Konings, {Constantijn J A M} and {Kremer Hovinga}, {Ton K} and Molenaar, {Femke M} and {van der Weerd}, {Neelke C} and Grooteman, {Muriel P C}",
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de Roij van Zuijdewijn, CLM, Chapdelaine, I, Nubé, MJ, Blankestijn, PJ, Bots, ML, Konings, CJAM, Kremer Hovinga, TK, Molenaar, FM, van der Weerd, NC & Grooteman, MPC 2017, 'Achieving high convection volumes in postdilution online hemodiafiltration: a prospective multicenter study' Clinical kidney journal, vol. 10, no. 6, pp. 804-812. https://doi.org/10.1093/ckj/sfw140

Achieving high convection volumes in postdilution online hemodiafiltration : a prospective multicenter study. / de Roij van Zuijdewijn, Camiel L M; Chapdelaine, Isabelle; Nubé, Menso J; Blankestijn, Peter J; Bots, Michiel L; Konings, Constantijn J A M; Kremer Hovinga, Ton K; Molenaar, Femke M; van der Weerd, Neelke C; Grooteman, Muriel P C.

In: Clinical kidney journal, Vol. 10, No. 6, 12.2017, p. 804-812.

Research output: Contribution to journalArticleProfessional

TY - JOUR

T1 - Achieving high convection volumes in postdilution online hemodiafiltration

T2 - a prospective multicenter study

AU - de Roij van Zuijdewijn, Camiel L M

AU - Chapdelaine, Isabelle

AU - Nubé, Menso J

AU - Blankestijn, Peter J

AU - Bots, Michiel L

AU - Konings, Constantijn J A M

AU - Kremer Hovinga, Ton K

AU - Molenaar, Femke M

AU - van der Weerd, Neelke C

AU - Grooteman, Muriel P C

PY - 2017/12

Y1 - 2017/12

N2 - Background. Available evidence suggests a reduced mortality risk for patients treated with high-volume postdilution hemodiafiltration (HDF) when compared with hemodialysis (HD) patients. As the magnitude of the convection volume depends on treatment-related factors rather than patient-related characteristics, we prospectively investigated whether a high convection volume (defined as ≥22 L/session) is feasible in the majority of patients (>75%). Methods. A multicenter study was performed in adult prevalent dialysis patients. Nonparticipating eligible patients formed the control group. Using a stepwise protocol, treatment time (up to 4 hours), blood flow rate (up to 400 mL/min) and filtration fraction (up to 33%) were optimized as much as possible. The convection volume was determined at the end of this optimization phase and at 4 and 8 weeks thereafter. Results. Baseline characteristics were comparable in participants (n = 86) and controls (n = 58). At the end of the optimization and 8 weeks thereafter, 71/86 (83%) and 66/83 (80%) of the patients achieved high-volume HDF (mean 25.5 ± 3.6 and 26.0 ± 3.4 L/session, respectively). While treatment time remained unaltered, mean blood flow rate increased by 27% and filtration fraction increased by 23%. Patients with <22 L/session had a higher percentage of central venous catheters (CVCs), a shorter treatment time and lower blood flow rate when compared with patients with ≥22 L/session. Conclusions. High-volume HDF is feasible in a clear majority of dialysis patients. Since none of the patients agreed to increase treatment time, these findings indicate that high-volume HDF is feasible just by increasing blood flow rate and filtration fraction.

AB - Background. Available evidence suggests a reduced mortality risk for patients treated with high-volume postdilution hemodiafiltration (HDF) when compared with hemodialysis (HD) patients. As the magnitude of the convection volume depends on treatment-related factors rather than patient-related characteristics, we prospectively investigated whether a high convection volume (defined as ≥22 L/session) is feasible in the majority of patients (>75%). Methods. A multicenter study was performed in adult prevalent dialysis patients. Nonparticipating eligible patients formed the control group. Using a stepwise protocol, treatment time (up to 4 hours), blood flow rate (up to 400 mL/min) and filtration fraction (up to 33%) were optimized as much as possible. The convection volume was determined at the end of this optimization phase and at 4 and 8 weeks thereafter. Results. Baseline characteristics were comparable in participants (n = 86) and controls (n = 58). At the end of the optimization and 8 weeks thereafter, 71/86 (83%) and 66/83 (80%) of the patients achieved high-volume HDF (mean 25.5 ± 3.6 and 26.0 ± 3.4 L/session, respectively). While treatment time remained unaltered, mean blood flow rate increased by 27% and filtration fraction increased by 23%. Patients with <22 L/session had a higher percentage of central venous catheters (CVCs), a shorter treatment time and lower blood flow rate when compared with patients with ≥22 L/session. Conclusions. High-volume HDF is feasible in a clear majority of dialysis patients. Since none of the patients agreed to increase treatment time, these findings indicate that high-volume HDF is feasible just by increasing blood flow rate and filtration fraction.

KW - Journal Article

U2 - 10.1093/ckj/sfw140

DO - 10.1093/ckj/sfw140

M3 - Article

VL - 10

SP - 804

EP - 812

JO - Clinical kidney journal

JF - Clinical kidney journal

SN - 2048-8505

IS - 6

ER -