Modifiable Factors Associated with Achievement of High-Volume Post-Dilution Hemodiafiltration: Results from An International Study. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Marcelli, Daniele; Kopperschmidt, Pascal; Bayh, Inga; Jirka, Tomas; Merello, Jose I.; Ponce, Pedro; Ladanyi, Erzebeth; Di Benedetto, Attilio; Dovc-Dimec, Reina; Rosenberger, Jaroslav; Stuard, Stefano; Scholz, Caecilia; Grassmann, Aileen; Canaud, Bernard
• Is Part Of: International journal of artificial organs. Volume 38:Issue 5(2015:May)
• Page Start: 244
• Page End: 250
• Publication Date: 2015-05
• Subjects: Convection -- Dose -- Hemodiafiltration -- Substitution fluid -- Volume; Artificial organs -- Periodicals; 617.956
• DOI: 10.5301/ijao.5000414
• Languages: English
• ISSNs: 0391-3988

Abstract

Background: The aim was to investigate factors associated with the successful achievement of ≥21 l/session of substitution fluid volume in patients on post-dilution hemodiafiltration. Methods: 3315 patients treated in 6 European countries with the Fresenius 5008 CorDiax machine including the AutoSub Plus feature were considered. Variables that showed a relationship with convection volume were entered in a multivariable logistic regression model. Results: Mean blood flow was 379 ± 68 ml/min. Median substitution volume was 24.7 L (IQR 22.0–27.4 L). Mean filtration fraction was 28.3 ± 4.1%. 81.5% of sessions qualified as high-volume HDF (substitution volumes ≥21 L). Higher age, dialyzer surface area, blood flow and treatment time were positively associated with the achievement of ≥21 L substitution volume; higher body mass index, male gender, higher hematocrit, graft or catheter vs. fistula, and start of week vs. mid-week were negatively associated. Conclusions: Dialysis center policy in terms of blood flow, treatment time, filter size, and perhaps even hemoglobin targets plays a key role in achieving high-volume HDF. All of these are modifiable factors that can help in prescribing an optimal combination of dialyzer size, achievable blood flows, and treatment times.