Online haemodiafiltration therapy to treat chronic kidney disease. First national experience in the university hospital
DOI:
https://doi.org/10.29193/RMU.36.1.5Keywords:
RENAL DIALYSIS, HEMODIAFILTRATION ONLINE, MORTALITYAbstract
Chronic kidney disease has an estimated prevalence of 6.5% to 8% in adults older than 18 years old in Uruguay. Despite efforts to make an early diagnosis and delay its progression, a percentage of patients require renal replacement therapy (RRT) with dialysis, the annual incidence rate being 166 patients per million population. Regardless of improvements in nephrology care and hemodialysis techniques, annual mortality ratex for this technique is high in our country (16.5%) and around the world. In order to improve these aspects, different dialysis techniques associating convection as a strategy to purify larger molecules that are rarely purified in conventional hemodialysis have been tried out. Online haemodiafiltration (OL-HDF) is a convective technique. When used as a chronic RRT it is associated to a 30-35% reduction in mortality compared to conventional hemodialysis. In 2014 this technique was introduced in the University Hospital, being it the first center that offered it as chronic renal replacement therapy. The implementation process implied changes in infrastructure (dialysis computer screens, water treatment center), the training of human resources, changes in the operation system and programmed microbiological controls.
A systematic quality control and the different studies conducted in this 5-year period have proved it is a safe technique that removes average size solutes and reduces the erythropoietin requirements. This technique is still not funded by the health system, what may result in an obstacle for it to be applied nationally.
This study reviews the main features of haemodiafiltration, its benefits when compared to conventional hemodialysis and the process needed to implement the technique, along with initial results in the University Hospital.
References
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(19) Canaud B, Wizemann V, Pizzarelli F, Greenwood R, Schultze G, Weber C, et al. Cellular interleukin-1 receptor antagonist production in patients receiving on-line haemodiafiltration therapy. Nephrol Dial Transplant 2001; 16(11):2181-7. doi: 10.1093/ndt/16.11.2181.
(20) Donauer J, Schweiger C, Rumberger B, Krumme B, Böhler J. Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis. Nephrol Dial Transplant 2003; 18(8):1616-22. doi: 10.1093/ ndt/gfg206.
(21) Bégin V, Déziel C, Madore F. Biofeedback regulation of ultrafiltration and dialysate conductivity for the prevention of hypotension during hemodialysis. ASAIO J 2002; 48(3):312-5. doi: 10.1097/00002480-200205000-00018.
(22) Guth H, Gruska S, Kraatz G. On-line production of ultrapure substitution fluid reduces TNF-alpha- and IL-6 release in patients on hemodiafiltration therapy. Int J Artif Organs 2003; 26(3):181-7. doi: 10.1177/039139880302600301.
(23) Maduell F, del Pozo C, García H, Sánchez L, Hdez-Jaras J, Albero M, et al. Change from conventional haemodiafiltration to on-line haemodiafiltration. Nephrol Dial Transplant 1999; 14(5):1202-7. doi: 10.1093/ndt/14.5.1202.
(24) Shroff R, Smith C, Ranchin B, Bayazit A, Stefanidis C, Askiti V, et al. Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, heart and height study. J Am Soc Nephrol 2019; 30(4):678-691. doi: 10.1681/ASN.2018100990.
(25) Baccino C, Larre Borges P, Alvarez D, Phillips C, González F, Noboa O, et al. Desarrollo de la hemodiafiltración en línea en el Centro de Nefrología del Hospital de Clínicas: técnica de terapia de sustitución de la función renal. En: X Congreso Uruguayo de Nefrología: libro de resúmenes. Montevideo: Sociedad Uruguaya de Nefrología, 2016:16.
(26) Blanco J, Castillo T, Chifflet L, Leiva G, Nin M, Opertti A, et al. Guía de gestión de calidad del agua para diálisis. 2 ed. Montevideo: FNR, 2014.
(27) Larre Borges P, Zulberti C, Villegas N, Sarantes R, Ferrari S, Luzardo L, et al. Aumento de la depuración de moléculas medias con hemodiafiltración on line en al paciente crónico. En: X Congreso Uruguayo de Nefrología: libro de resúmenes. Montevideo: Sociedad Uruguaya de Nefrología, 2016:14.
(28) Flores R, Guerisoli A, Yosi C, Gauronas P, Iglesias P, Baccino C, et al. Hemodiafiltración-en línea (HDF-L) crónica: seguimiento de los primeros 17 pacientes. En: XI Congreso Uruguayo de Nefrología y V Jornadas Rioplatenses de Nefrología: libro de resúmenes. Montevideo: Sociedad Uruguaya de Nefrología, 2018:31.
(2) Ríos Sarro P, Sola L, Gadola L. Prevalence of CKD in Uruguay. En: García-García G, Agodoa LY, Norris KC, eds. Chronic kidney disease in disadvantaged populations. London: Elsevier, 2017:35-44. doi: 10.1016/B978-0-12- 804311-0.00005-4.
(3) Schwedt E, Solá L, Ríos P, Mazzuchi N. Improving the management of chronic kidney disease in Uruguay: a National Renal Healthcare Program. Nephron Clin Pract 2010; 114(1):c47-59. doi: 10.1159/000245069.
(4) González Bedat C, Ferreiro A, Chifflet L, Ceretta ML. Registro uruguayo de diálisis: informe Anual 2016. Montevideo: Sociedad Uurguaya de Nefrología, 2016.
(5) Rayner H, Pisoni R, Bommer J, Canaud B, Hecking E, Locatelli F, et al. Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004; 19(1):108-20. doi: 10.1093/ ndt/gfg483.
(6) Sellarés VL. Hemodiáisis: principios físicos: definiciones y conceptos. En: Lorenzo V, Lòpez Gómez JM, eds. Nefrología al día. Madrid: SEN, 2018:355-68.
(7) Fernández M, Teruel JL. Técnicas de hemodiálisis. En: Lorenzo V, López Gómez JM, eds. Nefrología al día. Madrid: SEN, 2018:437-46.
(8) Blankestijn P, Grooteman M, Nube M, Bots M. Clinical evidence on haemodiafiltration. Nephrol Dial Transplant 2018; 33(suppl 3):iii53-iii58. doi: 10.1093/ndt/gfy218.
(9) Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, et al. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 2013; 24(3):487-97. doi: 10.1681/ASN.2012080875.
(10) Canaud B, Bragg-Gresham J, Marshall M, Desmeules S, Gillespie B, Depner T, et al. Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS. Kidney Int 2006; 69(11):2087-93. doi: 10.1038/sj.ki.5000447.
(11) Kikuchi K, Hamano T, Wada A, Nakai S, Masakane I. Predilution online hemodiafiltration is associated with improved survival compared with hemodialysis. Kidney Int 2019; 95(4):929-38. doi: 10.1016/j.kint.2018.10.036.
(12) Krieter D, Collins G, Summerton J, Spence E, Moragues H, Canaud B. Mid-dilution on-line haemodiafiltration in a standard dialyser configuration. Nephrol Dial Transplant 2005; 20(1):155-60. doi: 10.1093/ndt/gfh520.
(13) Ward R, Schmidt B, Hullin J, Hillebrand G, Samtleben W. A comparison of on-line hemodiafiltration and high-flux hemodialysis: a prospective clinical study. J Am Soc Nephrol 2000; 11(12):2344-50.
(14) Wizemann V, Lotz C, Techert F, Uthoff S. On-line haemodiafiltration versus low-flux haemodialysis. A prospective randomized study. Nephrol Dial Transplant 2000; 15(Suppl 1):43-8. doi: 10.1093/oxfordjournals.ndt.a027963.
(15) Maduell F, Navarro V, Torregrosa E, Rius A, Dicenta F, Cruz M, et al. Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration. Kidney Int 2003; 64(1):305-13. doi: 10.1046/j.1523-1755.2003.00043.x.
(16) Maduell F, Navarro V, Cruz M, Torregrosa E, Garcia D, Simon V, et al. Osteocalcin and myoglobin removal in on-line hemodiafiltration versus low- and high-flux hemodialysis. Am J Kidney Dis 2002; 40(3):582-9. doi: 10.1053/ajkd.2002.34918.
(17) Bammens B, Evenepoel P, Verbeke K, Vanrenterghem Y. Removal of the protein-bound solute p-cresol by convective transport: a randomized crossover study. Am J Kidney Dis 2004; 44(2):278-85. doi: 10.1053/j.ajkd.2004.04.033.
(18) Gerdemann A, Wagner Z, Solf A, Bahner U, Heidland A, Vienken J, et al. Plasma levels of advanced glycation end products during haemodialysis, haemodiafiltration and haemofiltration: potential importance of dialysate quality. Nephrol Dial Transplant 2002; 17(6):1045-9. doi: 10.1093/ ndt/17.6.1045.
(19) Canaud B, Wizemann V, Pizzarelli F, Greenwood R, Schultze G, Weber C, et al. Cellular interleukin-1 receptor antagonist production in patients receiving on-line haemodiafiltration therapy. Nephrol Dial Transplant 2001; 16(11):2181-7. doi: 10.1093/ndt/16.11.2181.
(20) Donauer J, Schweiger C, Rumberger B, Krumme B, Böhler J. Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis. Nephrol Dial Transplant 2003; 18(8):1616-22. doi: 10.1093/ ndt/gfg206.
(21) Bégin V, Déziel C, Madore F. Biofeedback regulation of ultrafiltration and dialysate conductivity for the prevention of hypotension during hemodialysis. ASAIO J 2002; 48(3):312-5. doi: 10.1097/00002480-200205000-00018.
(22) Guth H, Gruska S, Kraatz G. On-line production of ultrapure substitution fluid reduces TNF-alpha- and IL-6 release in patients on hemodiafiltration therapy. Int J Artif Organs 2003; 26(3):181-7. doi: 10.1177/039139880302600301.
(23) Maduell F, del Pozo C, García H, Sánchez L, Hdez-Jaras J, Albero M, et al. Change from conventional haemodiafiltration to on-line haemodiafiltration. Nephrol Dial Transplant 1999; 14(5):1202-7. doi: 10.1093/ndt/14.5.1202.
(24) Shroff R, Smith C, Ranchin B, Bayazit A, Stefanidis C, Askiti V, et al. Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, heart and height study. J Am Soc Nephrol 2019; 30(4):678-691. doi: 10.1681/ASN.2018100990.
(25) Baccino C, Larre Borges P, Alvarez D, Phillips C, González F, Noboa O, et al. Desarrollo de la hemodiafiltración en línea en el Centro de Nefrología del Hospital de Clínicas: técnica de terapia de sustitución de la función renal. En: X Congreso Uruguayo de Nefrología: libro de resúmenes. Montevideo: Sociedad Uruguaya de Nefrología, 2016:16.
(26) Blanco J, Castillo T, Chifflet L, Leiva G, Nin M, Opertti A, et al. Guía de gestión de calidad del agua para diálisis. 2 ed. Montevideo: FNR, 2014.
(27) Larre Borges P, Zulberti C, Villegas N, Sarantes R, Ferrari S, Luzardo L, et al. Aumento de la depuración de moléculas medias con hemodiafiltración on line en al paciente crónico. En: X Congreso Uruguayo de Nefrología: libro de resúmenes. Montevideo: Sociedad Uruguaya de Nefrología, 2016:14.
(28) Flores R, Guerisoli A, Yosi C, Gauronas P, Iglesias P, Baccino C, et al. Hemodiafiltración-en línea (HDF-L) crónica: seguimiento de los primeros 17 pacientes. En: XI Congreso Uruguayo de Nefrología y V Jornadas Rioplatenses de Nefrología: libro de resúmenes. Montevideo: Sociedad Uruguaya de Nefrología, 2018:31.
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2020-03-31
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Silvariño R, Baccino C, Larre Borges P, Guerisoli AL, Miranda V, Búcalo P, et al. Online haemodiafiltration therapy to treat chronic kidney disease. First national experience in the university hospital. Rev. Méd. Urug. [Internet]. 2020 Mar. 31 [cited 2024 Nov. 21];36(1):39-44. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/496
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