OPTIMIZED CONVECTIVE VOLUME IN ONLINE HEMODIAFILTRATION

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Autoři: František Lopot ^1,2; Vratislav Fabián ³
Působiště autorů: Department of Medicine, General University Hospital in Prague, Prague-Strahov, Czech Republic ¹; Institute of Biophysics and Medical Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic ²; Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic ³
Vyšlo v časopise: Lékař a technika - Clinician and Technology No. 3, 2020, 50, 77-84
Kategorie: Original research
doi: https://doi.org/10.14311/CTJ.2020.3.01

Souhrn

Hemodiafiltration (HDF) adds convective elimination of middle molecules (MM), proportional to filtered volume (V_conv) on the top of diffusion-based elimination of small molecules (SM) by conventional hemodialysis (HD). Studies, both observational and randomized controlled ones, performed so far generally indicated positive impact of higher V_conv on all-cause mortality in HDF patients, although the magnitude of V_conv at which HDF becomes apparently superior to HD differed widely among the studies. Also the issue of a suitable anthropometric parameter by which the V_conv should be normalized has not yet been solved. Data from the ESHOL study seems to indicate that patient´s body surface area (BSA) could well be used for this—mortality was decreasing with increasing V_conv/BSA with a bottom plateau starting at about 15 L/m². We have therefore devised a formula and a graph for determination of V_conv which fulfils the requirement V_conv/BSA = 15. Assuming maximum feasible and safe filtration fraction QF/QB = 0.3, the V_conv actually defines the necessary blood flow (QB) to reach V_conv/BSA = 15 as QB = 15·BSA/(0.3·t) (t – session time). It is also possible to check what QB is needed in terms of sufficient diffusion-based transport (target Kt/V) and compare both QB values to see if adequate combined elimination of both SM and MM can be achieved at the same time and under what conditions, respectively.

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