Systematic Comparison of Uremic Toxin Removal Using Different Hemodialysis Modes: A Single-Center Crossover Prospective Observational Study
Ariane Duval-Sabatier,
Stephane Burtey,
Marion Pelletier,
Manon Laforet,
Laetitia Dou,
Marion Sallee,
Anne-Marie Lorec,
Hafssa Knidiri,
Floriane Darbon,
Yvon Berland,
Philippe Brunet
Affiliations
Ariane Duval-Sabatier
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Stephane Burtey
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Marion Pelletier
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Manon Laforet
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Laetitia Dou
INSERM, C2VN, INRA, Aix Marseille University, 13005 Marseille, France
Marion Sallee
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Anne-Marie Lorec
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Hafssa Knidiri
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Floriane Darbon
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Yvon Berland
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Philippe Brunet
Centre de Néphrologie et Transplantation Rénale, Assistance-Publique–Hôpitaux de Marseille, Hôpital de la Conception 147 Bd Baille, 13005 Marseille, France
Many hypotheses could explain the mortality decrease observed using hemodiafiltration, such as reduction of intradialytic hypotension and more efficient toxin removal. We led a systematic analysis of representative uremic toxin removal with hemodialysis (HD), online postdilution hemodiafiltration (postHDF) and online predilution hemodiafiltration (preHDF), in a single-center crossover and prospective observational study. The primary outcome was the reduction ratio of uremic toxins of the three categories defined by the Eutox group. Twenty-six patients were treated by those three techniques of extra renal epuration. Mean Kt/Vurea was not different between the treatment methods. Mean reduction ratio of beta2microglobulin was significantly higher for both HDF treatments than for HD (p p < 0.001). Mean protein-bound solutes reduction ratio was not different between the different treatments except for PCS with a higher reduction ratio during HDF treatments. Mean albumin loss was always less than 2 g. HDF improved removal of middle molecules but had no effect on indoles concentration without any difference between synthetic dialysis membranes.
