Hemodiafiltration with online regeneration of the ultrafiltrate

Hemodiafiltration with online regeneration of the ultrafiltrate. The concept of regeneration of dialysis fluids and of ultrafiltrate in particular has been recently revisited. Hemodiafiltration with online regeneration of the ultrafiltrate allows the concomitant infusion of sodium, calcium, and bica...

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Bibliographic Details
Published in:Kidney international 2000-08, Vol.58 (S76), p.S66-S71
Main Authors: De Francisco, Angel Luis Martinez, Ghezzi, Paolo M., Brendolan, Alessandra, Fiorini, Fulvio, La Greca, Giuseppe, Ronco, Claudio, Arias, Manuel, Gervasio, Renzo, Tetta, Ciro
Format: Article
Language:English
Subjects:
biocompatibility
chronic renal failure
dialysate
immunomodulation
infusion
sterility
two-step sorbent system
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Summary:Hemodiafiltration with online regeneration of the ultrafiltrate. The concept of regeneration of dialysis fluids and of ultrafiltrate in particular has been recently revisited. Hemodiafiltration with online regeneration of the ultrafiltrate allows the concomitant infusion of sodium, calcium, and bicarbonate. Here, we studied the adsorptive characteristics of an integrated two-step sorbent system relative to different solutes present in the ultrafiltrate: sodium, calcium, phosphate, bicarbonate, uric acid, creatinine, and β2-microglobulin. In vitro studies were performed in order to differentiate the relative roles for each sorbent (mineral-activated charcoal or hydrophobic resin) in adsorbing a given solute. Ex vivo studies were performed in order to evaluate the presence of cytokines (interleukin-1β and tumor necrosis factor-α), of cytokine (interleukin-1β and tumor necrosis factor-α)-inducing activities, and of the cytokine release in response to exogenous bacterial lipopolysaccharide by normal whole blood incubated with ultrafiltrate samples obtained at 15, 120, and 240 minutes after the start of treatment. The results of the present studies show the presence of immunomodulatory substances in the ultrafiltrate and the significant (P < 0.01) increase in the lipopolysaccharide-induced release of both interleukin-1β and tumor necrosis factor-α. The biological relevance of the ultrafiltrate and the possible relevance of the online, endogenous reinfusion are discussed.
ISSN:0085-2538
1523-1755
DOI:10.1046/j.1523-1755.2000.07608.x