Hemodialysis Complication

Hemodialysis

Saint-Georges Hospital

Twice Against Thrice-weekly Hemodialysis

Twice-Against Thrice-weekly Hemodialysis: the TATH Trial

Rate of supplementary hemodialysis sessions for pulmonary oedema or hyperkalemia

Rate of uncontrolled hypertension, Uncontrolled hypertension is defined as a pre-dialysis BP > 160/90 in more than 2/3 of the sessions.

Mabel Aoun

Dr Mabel Aoun. Head of the Department of Nephrology, Saint-Georges Hospital Ajaltoun

Saint-Joseph University

The olHDF technique combines diffusion with high convection rates in which the dialysis fluid, free of toxins and pyrogens, is used to prepare the replacement fluid.
The online module of dialysis machine prepares the replacement fluid by a cold sterilization process. There is a cross-flow water preparation, in order to avoid the accumulation of possible contaminants. The addition of bicarbonate and acid solutions to water follows the process. Next, the ready-for-infusion dialysis solution is passed through another ultrafilter prior to being infused into patients.

More recently, membranes with high cutoff values, but with tight pore size distribution have been developed. The main concept is to keep both cutoff and retention onset values close to each other, but with a cutoff value lower than of albumin. This should allow removal of middle-to-high weight range uremic toxins, with very low albumin leak. Thus, these membranes, denominated high retention onset (HRO) membranes, allow performing both diffusive and convective processes in a conventional hemodialysis machine.

Patients were included in this study group per sequence:
Online hemodiafiltration (olHDF) first for 1 month, then expanded hemodialysis (HDx) for 1 month.
Baseline characteristics assessed:
Age
Gender
Ethnicity
Region of Enrollment
Serum Beta-2 Microglobulin

Online Hemodiafiltration

Patients were included in this study group per sequence:
Expanded hemodialysis (HDx) first for 1 month, then online hemodiafiltration (olHDF) for 1 month.
Baseline characteristics assessed:
Age
Gender
Ethnicity
Region of Enrollment
Serum Beta-2 Microglobulin

Expanded Hemodialysis

Total

Sex: Female, Male

Ethnicity (NIH/OMB)

Region of Enrollment

Serum Beta-2 Microglobulin

High cutoff with high retention onset dialyzers allow clearance of middle molecules, without reducing significantly serum concentration of albumin.

Medium Molecule Clearance

Medium Molecule Removal

Intradialytic Hemodynamics

noninvasive assessment of extracellular and total body water

Fluid Status

Arm description: Online Hemodiafiltration first, then expanded hemodialysis.
First, patients changed fom conventional HD to online hemodiafiltration for 1 month.
Then, patients returned to conventional HD for 2 weeks (washout period). Then, patients underwent the second intervention (expanded hemodialysis) for 1 month, in a cross-over design.

Arm description: expanded hemodialysis first, then online hemodiafiltration.
Intervention: Conversion from conventional HD to expanded hemodialysis for 1 month.
Then, patients returned to conventional HD for 2 weeks (washout period). Then, they underwent the second intervention (online hemodiafiltration), for 1 month, in a cross-over design.

First Intervention

Washout Period

Second Intervention

Dr. Bruno Caldin da Silva

The olHDF technique combines diffusion with high convection rates in which the dialysis fluid, free of toxins and pyrogens, is used to prepare the replacement fluid.
The online module of dialysis machine prepares the replacement fluid by a cold sterilization process. There is a cross-flow water preparation, in order to avoid the accumulation of possible contaminants. The addition of bicarbonate and acid solutions to water follows the process. Next, the ready-for-infusion dialysis solution is passed through another ultrafilter prior to being infused into patients.
Online Hemodiafiltration: Intervention: Conversion from conventional HD to online Hemodiafiltration por 1 month.
Online hemodiafiltration has been associated with lower incidence of intradialytic hypotension in comparison to conventional hemodialysis.

More recently, membranes with high cutoff values, but with tight pore size distribution have been developed. The main concept is to keep both cutoff and retention onset values close to each other, but with a cutoff value lower than of albumin. This should allow removal of middle-to-high weight range uremic toxins, with very low albumin leak. Thus, these membranes, denominated high retention onset (HRO) membranes, allow performing both diffusive and convective processes in a conventional hemodialysis machine. Expanded Hemodialysis: Intervention: Conversion from conventional HD to expanded hemodialysis por 1 month.
High cutoff with high retention onset dialyzers allow clearance of middle molecules, without reducing serum concentration of albumin. It allows higher convective clearance in comparison to conventional hemodialysis, but it is unknown if such clearance is similar to online hemodiafiltration. Therefore, the aim of the present intervention is to compare this dialy

Dialysis Related Complication

Dialysis Hypotension

Hemodialysis-Induced Symptom

Intervention: Conversion from conventional HD to expanded hemodialysis por 1 month.
High cutoff with high retention onset dialyzers allow clearance of middle molecules, without reducing significantly serum concentration of albumin. It allows higher convective clearance in comparison to conventional hemodialysis, but it is unknown if such clearance is similar to online hemodiafiltration. Therefore, the aim of the present intervention is to compare this dialyzer with online hemodiafiltration

Intervention: Conversion from conventional HD to online Hemodiafiltration por 1 month.
Online hemodiafiltration has been associated with lower incidence of intradialytic hypotension in comparison to conventional hemodialysis.

Hospital das Clínicas

Expanded Hemodialysis Versus Online Hemodiafiltration

Expanded Hemodialysis Versus Online Hemodiafiltration: a Pilot Study on Intradialytic Hemodynamics and Fluid Status

Bruno Caldin da Silva

Principal Investigator

University of Sao Paulo

Investigator who collects laboratorial, hemodynamics and bioimpedance data will be blinded for intervention (online hemodiafiltration or expanded hemodialysis)

additive is put in the dialysate to increase the concentration of glucose to 10mmol/l

Standard 5.5 mmol/L dialysate glucose concentration.

High Dialysate Bath

Standard Dialysate Glucose Concentration

record number of episodes during dialysis with serum glucose below 4 mmol/L by glucometer

additive is put in the dialysate to increase the concentration of glucose to 10mmol/l
High Dialysate bath: The dialysate bath assigned is 10mmol/L glucose, while the control group is assigned to 5.5 mmol/l glucose solution.

Episodes of Hypoglycemia

Hemoglobin A1c Levels

Hemoglobin A1c levels will be measured before the intervention and after to assess any difference in the value. The blood samples were taken prior to dialysis treatments mid-week for each subject at baseline and at the end of the study in both the control and intervention groups.

To Record the Effects of a Higher Dialysate Concentration of Glucose on Glycemic Control of Hemodialysis Patients With Type 2 Diabetes Mellitus by Measuring Serum Levels of Hemoglobin A1c.

In the two groups, we will measure the number of episodes of vascular access related infections ie. catheter, AV fistula or AV graft associated infections in the study period. The episode was defined as a diagnosis in the chart written by the nurse or physician with a prescription of antibiotics.

the Number of Infections Related to Vascular Access in Dialysis Among Those Who Receive a Higher Glucose Concentration in the Dialysate and Those Who Receive the Standard Concentration

Overall Study

Sameena Iqbal

Diabetes Type 2

The dialysate bath assigned is 10mmol/L glucose, while the control group is assigned to 5.5 mmol/l glucose solution.

High Dialysate bath

Montreal General Hospital

Effect of Dialysis Glucose Bath on Glycemic Control in Hemodialysis (HD)

The Effect of Glucose Concentration in the Dialysate Bath on Glycemic Control Among Hemodialysis Patients With Type 2 Diabetes Mellitus

Associate Professor

McGill University Health Centre/Research Institute of the McGill University Health Centre

Initial vascular access is a tunneled catheter, with or without a maturing AVF or AVG

arteriovenous fistula/albumina

Twice Against Thrice-weekly Hemodialysis

Expanded Hemodialysis Versus Online Hemodiafiltration

Effect of Dialysis Glucose Bath on Glycemic Control in Hemodialysis (HD)

A Study Evaluating the Association of Inflammation With Hemodialysis Access Type

O mais completo banco de dados de ervas medicinais apoiado pela ciência