Development of intermittent infusion hemodiafiltration using ultrapure dialysis fluid with an automated dialysis machine

Abstract

To reduce the potential occurrence of hypotension during a dialysis treatment, intermittent infusion hemodiafiltration (I-HDF) using back filtration with an ultrapure dialysis fluid was developed. Under typical I-HDF treatment conditions, some 200-300 ml of ultrapure dialysis fluid was infused into the blood component through the dialyzer at a rate of 100 ml/min, every 30 min. A multicenter clinical trial was carried out to evaluate the clinical effectiveness of I-HDF compared with standard hemodialysis (SHD). The peripheral blood flow rate of each patient as detected with a laser flow meter increased for each I-HDF infusion. A significantly lower value for averaged blood volume reduction was obtained with I-HDF compared with SHD in spite of there being no difference in the total amount of water removal. The amount of normalized solute removal, cleared space for inorganic phosphate and α1-microglobulin (α1-MG) during a treatment were higher with I-HDF. Moderate α1-MG K reduction was found in I-HDF due to the prevention of membrane fouling by intermittent back filtration of the dialysis fluid. I-HDF using an automated dialysis machine was effective for improvement of the peripheral circulation of dialysis patients.