Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities
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Published:2024-01-06
Issue:2
Volume:13
Page:326
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ISSN:2077-0383
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Container-title:Journal of Clinical Medicine
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language:en
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Short-container-title:JCM
Author:
Zakrzewska Agnieszka1, Biedunkiewicz Jan2, Komorniczak Michał1ORCID, Jankowska Magdalena1ORCID, Jasiulewicz Katarzyna1, Płonka Natalia1, Biedunkiewicz Bogdan1, Małgorzewicz Sylwia3ORCID, Tarasewicz Agnieszka1ORCID, Puchalska-Reglińska Ewelina4, Siebert Janusz5, Dębska-Ślizień Alicja1ORCID, Tylicki Leszek1ORCID
Affiliation:
1. Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland 2. Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland 3. Department of Clinical Nutrition, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland 4. Dialysis Unit, 7th Naval Hospital in Gdańsk, 80-305 Gdańsk, Poland 5. Department of Family Medicine, University Center for Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland
Abstract
There are several forms of maintenance high-efficiency hemodialysis (HD), including hemodiafiltrations (HDF) in different technical modes and expanded HD, using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, crossover study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialyses in random order: high-flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). Twenty-four dialysis sessions of each method were included in the analysis. Dialysis parameters, including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) L, respectively. During all therapies, patients were monitored for the similarity of their hydration statuses using bioimpedance spectroscopy, and for similar variability over time in systemic blood pressure and cardiac output, while peripheral resistance was monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance; however, the study results suggest that intradialytic tolerance and DRT may depend on the dialysis method used. This supports the need of taking into account patient preferences and quality of life while individualizing high-efficiency therapy in HD patients.
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