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Comparison of the pre-dilution and post-dilution methods for online hemodiafiltration

  • Original Article
  • Artificial Kidney / Dialysis
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Abstract

Online hemodiafiltration (OL-HDF) is a treatment modality using diffusion and ultrafiltration. There are two types of dilution methods in OL-HDF: pre-dilution, which is commonly provided in Japan, and post-dilution, which is commonly provided in Europe. The optimal OL-HDF method for individual patients is not well studied. In this study, we compared the clinical symptoms, laboratory data, spent dialysate, and adverse events of pre- and post-dilution OL-HDF. We conducted a prospective study of 20 patients who underwent OL-HDF between January 1, 2019 and October 30, 2019. Their clinical symptoms and dialysis efficacy were evaluated. All patients underwent OL-HDF every 3 months in the following sequence: first pre-dilution, post-dilution, and second pre-dilution. We evaluated 18 patients for the clinical study and 6 for the spent dialysate study. No significant differences in spent dialysates regarding small and large solutes, blood pressure, recovery time, and clinical symptoms were observed between the pre- and post-dilution methods. However, the serum α1-microglobulin level in post-dilution OL-HDF was lower than that in pre-dilution OL-HDF (first pre-dilution: 124.8 ± 14.3 mg/L; post-dilution: 116.6 ± 13.9 mg/L; second pre-dilution: 125.8 ± 13.0 mg/L; first pre-dilution vs. post-dilution, post-dilution vs. second pre-dilution, and first pre-dilution vs. second pre-dilution: p = 0.001, p < 0.001, and p = 1.000, respectively). The most common adverse event was an increase in transmembrane pressure in the post-dilution period. Compared to pre-dilution, the post-dilution method decreased the α1-microglobulin level; however, there were no significant differences in clinical symptoms or laboratory data.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Hoshino J, Yamagata K, Nishi S, Nakai S, Masakane I, Iseki K, et al. Carpal tunnel surgery as proxy for dialysis-related amyloidosis: results from the Japanese society for dialysis therapy. Am J Nephrol. 2014;39:449–58.

    Article  CAS  PubMed  Google Scholar 

  2. Panichi V, Rizza GM, Paoletti S, Bigazzi R, Aloisi M, Barsotti G, et al. Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study. Nephrol Dial Transplant. 2008;23:2337–43.

    Article  PubMed  Google Scholar 

  3. Panichi V, Paoletti S, Consani C. Inflammatory pattern in hemodiafiltration. Contrib Nephrol. 2008;161:185–90.

    Article  PubMed  Google Scholar 

  4. Susantitaphong P, Siribamrungwong M, Jaber BL. Convective therapies versus low-flux hemodialysis for chronic kidney failure: a meta-analysis of randomized controlled trials. Nephrol Dial Transplant. 2013;28:2859–74.

    Article  CAS  PubMed  Google Scholar 

  5. Nistor I, Palmer SC, Craig JC, Saglimbene V, Vecchio M, Covic A, et al. Convective versus diffusive dialysis therapies for chronic kidney failure: an updated systematic review of randomized controlled trials. Am J Kidney Dis. 2014;63:954–67.

    Article  PubMed  Google Scholar 

  6. Wang AY, Ninomiya T, Al-Kahwa A, Perkovic V, Gallagher MP, Hawley C, et al. Effect of hemodiafiltration or hemofiltration compared with hemodialysis on mortality and cardiovascular disease in chronic kidney failure: a systematic review and meta-analysis of randomized trials. Am J Kidney Dis. 2014;63:968–78.

    Article  PubMed  Google Scholar 

  7. Nitta K, Abe M, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, et al. Annual dialysis data report 2018, JSDT Renal Data Registry: dialysis fluid quality, hemodialysis and hemodiafiltration, peritoneal dialysis, and diabetes. Ren Replace Ther. 2020;6:51.

    Article  Google Scholar 

  8. Tsuchida K, Minakuchi J. Clinical benefits of predilution on-line hemodiafiltration. Blood Purif. 2013;35(Suppl 1):18–22.

    Article  PubMed  Google Scholar 

  9. Masakane I, Kikuchi K, Kawanishi H. Evidence for the clinical advantages of predilution on-line hemodiafiltration. Contrib Nephrol. 2017;189:17–23.

    Article  PubMed  Google Scholar 

  10. Kawanishi H. Development of online hemodiafiltration in Japan. Ren Replace Ther. 2021;7:51.

    Article  Google Scholar 

  11. Maduell F, Moreso F, Pons M, Ramos R, Mora-Macia J, Carreras J, et al. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol. 2013;24:487–97.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AH, et al. Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol. 2012;23:1087–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, et al. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant. 2013;28:192–202.

    Article  PubMed  Google Scholar 

  14. Sakurai K, Saito T, Yamauchi F, Asahi D, Hosoya H. Comparison of the effects of predilution and postdilution hemodiafiltration on neutrophils, lymphocytes and platelets. J Artif Organs. 2013;16:316–21.

    Article  CAS  PubMed  Google Scholar 

  15. Sakurai K, Saito T, Yamauchi F, Hosoya HH, Kurihara Y, Yoshida K, et al. Comparison of the effects of pre-dilution and post-dilution on-line hemodiafiltration on inflammatory markers, lymphocytes and platelets. Nephrol Dial Transplant. 2018;33:186–9.

    Article  Google Scholar 

  16. Mineshima M, Kawanishi H, Ase T, Kawasaki T, Tomo T, Nakamoto H. 2016 update Japanese Society for Dialysis Therapy Standard of fluids for hemodialysis and related therapies. Ren Replace Ther. 2018;4:15.

    Article  Google Scholar 

  17. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82.

    Article  PubMed  Google Scholar 

  18. Yamashita AC. The clear space index. Contrib Nephrol. 2017;189:197–203.

    Article  PubMed  Google Scholar 

  19. Gelman A, Hill J, Yajima M. Why we (usually) don’t have to worry about multiple comparisons. J Res Educ Eff. 2012;5:189–211.

    Google Scholar 

  20. Lopes AA, Albert JM, Young EW, Satayathum S, Pisoni RL, Andreucci VE, et al. Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney Int. 2004;66:2047–53.

    Article  PubMed  Google Scholar 

  21. Elder SJ, Pisoni RL, Akizawa T, Fissell R, Andreucci VE, Fukuhara S, et al. Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2008;23:998–1004.

    Article  PubMed  Google Scholar 

  22. Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69:1626–32.

    Article  CAS  PubMed  Google Scholar 

  23. Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66:1212–20.

    Article  PubMed  Google Scholar 

  24. Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2014;64:86–94.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maduell F, Ojeda R, Arias-Guillen M, Bazan G, Vera M, Fontsere N, et al. Assessment of dialyzer surface in online hemodiafiltration; objective choice of dialyzer surface area. Nefrologia. 2015;35:280–6.

    Article  PubMed  Google Scholar 

  26. Sakurai K. Biomarkers for evaluation of clinical outcomes of hemodiafiltration. Blood Purif. 2013;35(Suppl 1):64–8.

    Article  CAS  PubMed  Google Scholar 

  27. Maduell F, Arias-Guillen M, Fontsere N, Ojeda R, Rico N, Vera M, et al. Elimination of large uremic toxins by a dialyzer specifically designed for high-volume convective therapies. Blood Purif. 2014;37:125–30.

    Article  CAS  PubMed  Google Scholar 

  28. Grosjean F, Esposito P, Maccarrone R, Libetta C, Dal Canton A, Rampino T. RBP4: a culprit for insulin resistance in end stage renal disease that can be cleared by hemodiafiltration. Biomed Res Int. 2017; p. 7270595. https://doi.org/10.1155/2017/7270595.

  29. Akerstrom B, Maghzal GJ, Winterbourn CC, Kettle AJ. The lipocalin alpha1-microglobulin has radical scavenging activity. J Biol Chem. 2007;282:31493–503.

    Article  PubMed  Google Scholar 

  30. Rutardottir S, Karnaukhova E, Nantasenamat C, Songtawee N, Prachayasittikul V, Rajabi M, et al. Corrigendum to “Structural and biochemical characterization of two heme binding sites on alpha1-microglobulin using site directed mutagenesis and molecular simulation” [BBAPAP 1864/1 (2016) Page 29 to 41]. Biochim Biophys Acta Proteins Proteom. 2020;1868: 140394.

    Article  CAS  PubMed  Google Scholar 

  31. Kristiansson A, Bergwik J, Alattar AG, Flygare J, Gram M, Hansson SR, et al. Human radical scavenger alpha1-microglobulin protects against hemolysis in vitro and alpha1-microglobulin knockout mice exhibit a macrocytic anemia phenotype. Free Radic Biol Med. 2021;162:149–59.

    Article  CAS  PubMed  Google Scholar 

  32. Kurihara Y, Hosoya H, Kishihara R, Yoshinaga M, Iwadate Y, Yamauchi F, et al. Comparison of the effects of pre-dilution and post-dilution online hemodiafiltration on the levels of inflammatory markers, lymphocytes, and platelets. J Artif Organs. 2022;25:59–65.

    Article  CAS  PubMed  Google Scholar 

  33. Okada K, Michiwaki H, Mori H, Tashiro M, Inoue T, Shima H, et al. Removal performance of pre- and post-dilution online hemodiafiltration using identical hemodiafilters in the same patients. J Artif Organs 2022 [ahead of print].

  34. Cheung AK, Rocco MV, Yan G, Leypoldt JK, Levin NW, Greene T, et al. Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol. 2006;17:546–55.

    Article  CAS  PubMed  Google Scholar 

  35. Okuno S, Ishimura E, Kohno K, Fujino-Katoh Y, Maeno Y, Yamakawa T, et al. Serum beta2-microglobulin level is a significant predictor of mortality in maintenance haemodialysis patients. Nephrol Dial Transplant. 2009;24:571–7.

    Article  CAS  PubMed  Google Scholar 

  36. Watanabe Y, Kawanishi H, Suzuki K, Nakai S, Tsuchida K, Tabei K, et al. Japanese society for dialysis therapy clinical guideline for “Maintenance hemodialysis: hemodialysis prescriptions.” Ther Apher Dial. 2015;19 Suppl 1:67–92.

    Article  PubMed  Google Scholar 

  37. Nakai S, Masakane I, Shigematsu T, Hamano T, Yamagata K, Watanabe Y, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2007). Ther Apher Dial. 2009;13:457–504.

    Article  PubMed  Google Scholar 

  38. Sakurai K, Hosoya H, Kurihara Y, Yamauchi F, Suzuki A, Kurosawa K, et al. Evaluation of low-volume post-dilution online hemodiafiltration with Japanese high-performance hemodiafilters. J Artif Organs. 2020;23:234–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Albalate Ramon M, Martinez Miguel P, Bohorquez L, de Sequera P, Bouarich H, Perez-Garcia R, et al. Asymmetric cellulose triacetate is a safe and effective alternative for online haemodiafiltration. Nefrologia (Engl Ed). 2018;38:315–20.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Kayo Nishino, Junko Yamamoto, and Yoshihisa Taka for data collection and management.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Renal Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-Ku, Hiroshima, 730-8655, Japan

    Yusuke Kawai, Misaki Moriishi & Hideki Kawanishi

  2. Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan

    Kazuya Maeda & Takao Masaki

Authors
  1. Yusuke Kawai
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  2. Kazuya Maeda
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  3. Misaki Moriishi
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  4. Hideki Kawanishi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YK. The first draft of the manuscript was written by YK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kazuya Maeda or Takao Masaki.

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Kawai, Y., Maeda, K., Moriishi, M. et al. Comparison of the pre-dilution and post-dilution methods for online hemodiafiltration. J Artif Organs 27, 48–56 (2024). https://doi.org/10.1007/s10047-023-01391-2

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