Simultaneous blood temperature control and blood volume control reduces intradialytic symptoms.

PURPOSE: Intra-dialytic morbid events (IME; e.g. hypotension, cramps, headaches) are frequent complications during hemodialysis (HD), known to be associated with ultrafiltration-induced hypovolemia and body temperature changes. Feedback control of blood volume adjusts the ultrafiltration rate in order to keep the blood volume above the patient's individual limit; feedback control of blood temperature maintains the mean arterial blood temperature at the individual pre-dialytic level. Each of these methods reduces the frequency of IME. METHODS: In a randomized clinical trial the simultaneous application of both feedback controls was investigated for the first time. In 15 weeks, each patient went through 3 study phases: an observational screening phase, a standard phase (STD), and a blood temperature- and blood volume-control phase (CTL). Patients with at least 5 sessions with IME out of 15 sessions in the screening phase were eligible for the study and randomized either into sequence STD-CTL or CTL-STD. RESULTS: 26 patients completed the study according to protocol, and 778 HD treatments were analyzed. The general treatment parameters were similar in both study phases: treatment duration (STD: 244 min, CTL: 243 min, NS), pre-dialytic weight (STD: 72.3 kg, CTL: 72.2 kg, NS), and weight loss due to ultrafiltration (STD: 3.26 kg, CTL: 3.15 kg, NS). The proportion of HD treatments with IME was 32.8% during STD and 18.0% during CTL (p=0.024). CONCLUSIONS: The frequency of HD sessions with IME was significantly reduced by 45% compared to standard HD in this randomized clinical trial by use of individualized HD treatments with simultaneous feedback control of blood volume and blood temperature.

[Comparative analysis of the efficacy and biocompatibility of various methods of dialysis].

BACKGROUND/AIM: The efficacy and biocompatibility of hemodialysis have a singnificant impact on dialysis patient morbidity and mortality rate. The aim of our study was to compare the efficacy and biocompatibility of different hemodialysis modalities in our patients. METHODS: A total of 55 patients were included in the study, and on the basis of dialysis modality, they were divided in four groups: group I--post-dilution on-line hemodiafiltration (n=15), group II--bicarbonate high-flux polysulphone hemodialysis (n=15), group III--bicarbonate low-flux polysulphone hemodialysis (n=15), and groupe IV--bicarbonate cuprophane hemodialysis (n=10). The efficacy was evaluated on the basis of urea reduction rate (URR), urea Kt/V index and serum beta2-microglobuline reduction rate, and the biocompatibility was evaluated on the basis of the leukocyte count fall during the first fiftheen minutes of dialysis session, and of the serum C-reactive protein (CRP) level. RESULTS: The highest mean URR was achieved in the group I (70.53 +/- 6.49%), and it was significantly higher in comparison with the average URR in the group IV (54.8 +/- 6.35%) (p = 0.001). The average value of urea Kt/V index in the group I (1.48 +/- 0.22) was significantly higher in comparison with the average value in the group II 1.30 +/- 0.22 (p < 0.05), group III (1.05 +/- 0.22), and group IV (0.98 + 0.22) (p = 0.001). Serum beta2-microglobuline reduction rate was 68.93 +/- 8.25% in the group I, and 58.86 +/- 7.98% in the groupe II (p = 0.01). During the first 15 minutes of hemodialysis the leukocyte number was decreased by 12.57 +/- 9.35% in the group 1, 13.61 +/- 9.64% in the group 11, 18.3 +/- 13.24 in the group III and 62.3 +/- 15.4 in the group IV, on average. The mean serum level of CRP was 9.4 +/- 6.47 mg/l in the group IV, and less than 3.5 mg/l in the group I of the patients (p = 0.001). CONCLUSION: Postdilution on-line hemodiafiltration in comparison with standard hemodialysis provided the more effective elimination of small and middle uremic toxins molecules and a significantly higher degree of biocompatibility. The patients treated with standard hemodialysis frequently do not achieve the minimal value of urea Kt/V index prescribed by National Kidney Foundation-Dialysis Outcomes Quality Inatiatives standards. These patients also have significantly higher serum CRP values which suggest the state of chronic microinflammation.