Evaluation of low-volume post-dilution online hemodiafiltration with Japanese high-performance hemodiafilters

PURPOSE: To assess the removal performance of low-volume post-hemodiafiltration (HDF) with Japanese hemodiafilters and the removal performance with 20 % reduction in the total dialysate flow rate (Q(d)total). METHODS: Subjects were 8 patients undergoing pre-HDF. Study 1: Post-HDF was performed at a blood flow rate (Q(b)) of 250 mL/min and a total volume of substitution fluid (Vs) of 12 L/session(s) for 4 hrs using Fineflux-210Seco (FIX), ABH-21PA (ABH), and NVF-21H (NVF). We assessed removal efficiency of small molecular solutes, low-molecular-weight-proteins and the amount of albumin loss. Study 2: Post-HDF was performed at Vs of 12 L/s under G-1, Q(d)total of 500 and Q(b) of 250 mL/min; G-2, Q(d)total of 400 and Q(b) of 250 mL/min; and G-3, Q(d)total of 400 and Q(b) of 300 mL/min. Removal efficiency was compared and analyzed between these conditions. RESULTS: Study 1: The results using FIX, ABH and NVF are shown in order. The Kt/V were 1.8, 1.9 and 1.8. The β(2)-Microglobulin (MG) removal rate (RR) (%) were 81.2, 83.1 and 82.8, and the α(1)-MG RR were 37.4, 40.2 and 38.5, respectively. Study 2: The results in G-1, 2 and 3 are shown in order. The Kt/V and the RR of small solutes, were significantly higher in G-3. The β(2)-MG RR (%) were 81.2, 80.1 and 81.0, and the α(1)-MG RR were 37.4, 37.5 and 38.0, respectively. CONCLUSIONS: Low-volume post-HDF performed at Q(b) of 250 mL/min with Japanese high-performance hemodiafilters exhibited favorable removal efficiency for all solutes. Even with 20 % reduction in Q(d)total, the removal performance was also favorable.