Advertisement

Sodium removal and plasma tonicity balance are not different in hemodialysis and hemodiafiltration using high-flux membranes

  • Vincenzo La MiliaEmail author
  • Chiara Ravasi
  • Fabio Carfagna
  • Elena Alberghini
  • Ivano Baragetti
  • Laura Buzzi
  • Francesca Ferrario
  • Silvia Furiani
  • Gaia Santagostino Barbone
  • Giuseppe Pontoriero
Original Article
  • 23 Downloads

Abstract

Background

The clinical benefits of on-line hemodiafiltration (HDF) versus high-flux membranes hemodialysis (hf-HD) are still debated. In fact, although a superiority of one treatment over the other, especially in terms of mortality, did not emerge from the analysis of clinical trials, improved intradialytic vascular stability and cardiovascular mortality have been observed in patients undergoing HDF rather than hf-HD; the lower removal of sodium (Na+) during HDF seems to play a major role. The plasma concentration of Na+ is the major determinant of plasma tonicity, which, by determining the flow of water between the intracellular and the extracellular compartment, contributes to the vascular refilling process and the maintenance of blood pressure during the hemodialysis treatment. Plasma tonicity also depends on plasma glucose concentration, especially in patients with diabetes mellitus with hyperglycaemia at the start of hemodialysis treatment.

Materials and methods

We evaluated the removal of Na+ and plasma tonicity balance during a 2-week period by performing 2–3 consecutive sessions of hf-HD followed by 2–3 consecutive sessions of HDF, or vice versa, in 47 patients (40% diabetics) on chronic hemodialysis. Identical parameters were used in all dialytic sessions.

Results

Na+ removal per session was − 224 ± 144 mmol and − 219 ± 152 mmol, respectively, in hf-HD and in HDF (p = 0.79). The plasma tonicity balance per session was − 575 ± 310 mOsm and − 563 ± 328 mOsm, respectively, in hf-HD and in HDF (p = 0.75).

Conclusions

The removal of Na+ and plasma tonicity balance did not differ between hf-HD and HDF. This observation suggests that factors other than those assessed in our study might explain the improved cardiovascular stability reported in HDF.

Keywords

Sodium removal Plasma tonicity balance Hemodialysis Hemodiafiltration High-flux membranes 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

We have obtained informed consent from all patients enrolled in the study.

References

  1. 1.
    Grooteman MP, van den Dorpel MA, Bots ML et al (2012) Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 23(6):1087–1096CrossRefGoogle Scholar
  2. 2.
    Ok E, Asci G, Toz H et al (2013) Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF study. Nephrol Dial Transpl 28(1):192–202CrossRefGoogle Scholar
  3. 3.
    Maduell F, Moreso F, Pons M et al (2013) High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 24(3):487–497CrossRefGoogle Scholar
  4. 4.
    Morena M, Jaussent A, Chalabi L et al (2017) Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int 91(6):1495–1509CrossRefGoogle Scholar
  5. 5.
    Wang AY, Ninomiya T, Al-Kahwa A et al (2014) 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 63(6):968–978CrossRefGoogle Scholar
  6. 6.
    Nistor I, Palmer SC, Craig JC et al (2014) Convective versus diffusive dialysis therapies for chronic kidney failure: an updated systematic review of randomized controlled trials. Am J Kidney Dis 63(6):954–967CrossRefGoogle Scholar
  7. 7.
    Susantitaphong P, Siribamrungwong M, Jaber BL (2013) Convective therapies versus low-flux hemodialysis for chronic kidney failure: a meta-analysis of randomized controlled trials. Nephrol Dial Transpl 28(11):2859–2874CrossRefGoogle Scholar
  8. 8.
    Mostovaya IM, Blankestijn PJ, Bots ML et al (2014) Clinical evidence on hemodiafiltration: a systematic review and a meta-analysis. Semin Dial 27(2):119–127CrossRefGoogle Scholar
  9. 9.
    Panichi V, Rocchetti MT, Scatena A et al (2017) Long term variation of serum levels of uremic toxins in patients treated by post-dilution high volume on-line hemodiafiltration in comparison to standard low-flux bicarbonate dialysis: results from the REDERT study. J Nephrol 30(4):583–591CrossRefGoogle Scholar
  10. 10.
    Basile C, Davenport A, Blankestijn PJ (2017) Why choose high volume online post-dilution hemodiafiltration? J Nephrol 30(2):181–186CrossRefGoogle Scholar
  11. 11.
    Mion M, Kerr PG, Argiles A et al (1992) Haemodiafiltration in high-cardiovascular-risk patients. Nephrol Dial Transpl 7(5):453–454Google Scholar
  12. 12.
    Pizzarelli F, Cerrai T, Dattolo P et al (1998) Convective treatments with on-line production of replacement fluid: a clinical experience lasting 6 years. Nephrol Dial Transpl 13(2):363–369CrossRefGoogle Scholar
  13. 13.
    Maduell F, del Pozo C, Garcia H et al (1999) Change from conventional haemodiafiltration to on-line haemodiafiltration. Nephrol Dial Transpl 14(5):1202–1207CrossRefGoogle Scholar
  14. 14.
    Locatelli F, Altieri P, Andrulli S et al (2010) Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 21(10):1798–1807CrossRefGoogle Scholar
  15. 15.
    Pedrini LA, Ponti R, Faranna P et al (1991) Sodium modeling in hemodiafiltration. Kidney Int 40(3):525–532CrossRefGoogle Scholar
  16. 16.
    In: Narins RGE (ed) (1994) Maxwell and Kleeman’s clinical disorders of fluid and electrolyte metabolism. McGraw Hill, New York, pp 583–615Google Scholar
  17. 17.
    Flythe JE, Xue H, Lynch KE et al (2015) Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol 26:724–734CrossRefGoogle Scholar
  18. 18.
    Mc Causland FR, Waikar SS (2015) Association of predialysis calculated plasma osmolarity with intradialytic blood pressure decline. Am J Kidney Dis 66(3):499–506CrossRefGoogle Scholar
  19. 19.
    Song JH, Park GH, Lee SY et al (2005) Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances. J Am Soc Nephrol 16(1):237–246CrossRefGoogle Scholar
  20. 20.
    Kersh ES, Kronfield SJ, Unger A et al (1974) Autonomic insufficiency in uremia as a cause of hemodialysis-induced hypotension. N Engl J Med 290(12):650–653CrossRefGoogle Scholar
  21. 21.
    Cernaro V, Lacquaniti A, Lorenzano G et al (2012) Apelin, plasmatic osmolality and hypotension in dialyzed patients. Blood Purif 33(4):317–323CrossRefGoogle Scholar
  22. 22.
    Gennari FJ (1984) Current concepts. Serum osmolality. Uses and limitations. N Engl J Med 310(2):102–105CrossRefGoogle Scholar
  23. 23.
    Arieff AI, Massry SG, Barrientos A et al (1973) Brain water and electrolyte metabolism in uremia: effects of slow and rapid hemodialysis. Kidney Int 4(3):177–187CrossRefGoogle Scholar
  24. 24.
    Casino FG, Basile C (2018) A user-friendly tool for incremental haemodialysis prescription. Nephrol Dial Transpl 33(6):1046–1053CrossRefGoogle Scholar
  25. 25.
    Maggiore Q, Pizzarelli F, Zoccali C et al (1981) Effect of extracorporeal blood cooling on dialytic arterial hypotension. Proc Eur Dial Transpl Assoc 18:597–602Google Scholar
  26. 26.
    Maggiore Q, Pizzarelli F, Sisca S et al (1982) Blood temperature and vascular stability during hemodialysis and hemofiltration. Trans Am Soc Artif Intern Organs 28:523–527Google Scholar
  27. 27.
    Maggiore Q, Dattolo P, Piacenti M et al (1995) Thermal balance and dialysis hypotension. Int J Artif Organs 18(9):518–525CrossRefGoogle Scholar
  28. 28.
    Mahida BH, Dumler F, Zasuwa G et al (1983) Effect of cooled dialysate on serum catecholamines and blood pressure stability. Trans Am Soc Artif Intern Organs 29:384–389Google Scholar
  29. 29.
    Lucchi L, Fiore GB, Guadagni G et al (2004) Clinical evaluation of internal hemodiafiltration (iHDF): a diffusive-convective technique performed with internal filtration enhanced high-flux dialyzers. Int J Artif Organs 27(5):414–419CrossRefGoogle Scholar
  30. 30.
    Righetti M, Filiberti O, Ranghino A et al (2010) Internal hemodiafiltration versus low-flux bicarbonate dialysis: Results from a long-term prospective study. Int J Artif Organs 33(11):796–802CrossRefGoogle Scholar
  31. 31.
    Righetti M (2012) Internal hemodiafiltration. G Ital Nefrol 29(Suppl 55):S57–S61Google Scholar
  32. 32.
    Fiore GB, Guadagni G, Lupi A et al (2006) A new semiempirical mathematical model for prediction of internal filtration in hollow fiber hemodialyzers. Blood Purif 24(5–6):555–568CrossRefGoogle Scholar
  33. 33.
    Simic-Ogrizovic S, Backus G, Mayer A et al (2001) The influence of different glucose concentrations in haemodialysis solutions on metabolism and blood pressure stability in diabetic patients. Int J Artif Organs 24(12):863–869CrossRefGoogle Scholar
  34. 34.
    Lepeytre F, Ghannoum M, Ammann H et al (2017) Formulas for calculated osmolarity and osmolal gap: a study of diagnostic accuracy. Am J Kidney Dis 70(3):347–356CrossRefGoogle Scholar
  35. 35.
    Cornelis T, van der Sande FM, Eloot S et al (2014) Acute hemodynamic response and uremic toxin removal in conventional and extended hemodialysis and hemodiafiltration: a randomized crossover study. Am J Kidney Dis 64(2):247–256CrossRefGoogle Scholar
  36. 36.
    Randomized A (2017) Single-blind, crossover trial of recovery time in high-flux hemodialysis and hemodiafiltration. Am J Kidney Dis 69(6):762–770CrossRefGoogle Scholar
  37. 37.
    Donauer J, Schweiger C, Rumberger B et al (2003) Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis. Nephrol Dial Transpl 18(8):1616–1622CrossRefGoogle Scholar

Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  • Vincenzo La Milia
    • 1
    Email author
  • Chiara Ravasi
    • 2
  • Fabio Carfagna
    • 2
  • Elena Alberghini
    • 1
  • Ivano Baragetti
    • 1
  • Laura Buzzi
    • 1
  • Francesca Ferrario
    • 1
  • Silvia Furiani
    • 1
  • Gaia Santagostino Barbone
    • 1
  • Giuseppe Pontoriero
    • 2
  1. 1.Division of Nephrology and DialysisASST Nord Milano, E. Bassini HospitalCinisello BalsamoItaly
  2. 2.Nephrology and DialysisA. Manzoni HospitalLeccoItaly

Personalised recommendations