Long-Term Efficacy of Pre- and Post-Dilution Online
Hemodiafiltration with Dialyzer Reuse
Khajohn Tiranathanagul MD*, Paweena Susantitaphong MD*,
Chanmaly Keomany MD*,**, Nanta Mahatanan RN*,
Kearkiat Praditpornsilpa MD*, Somchai Eiam-Ong MD*
Affiliation :
* Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital,
Thai Red Cross Society and Faculty of Medicine,Chulalongkorn University, Bangkok, Thailand
** Nephrology-Hemodialysis Unit, Mittaphab Hospital, Vientiane, Lao PDR
Objective : Growing evidence has demonstrated the potential survival benefit of online hemodiafiltration (HDF) over conventional
hemodialysis (HD). Previous studies regarding online HDF utilized single-use dialyzer. The present study was conducted to
compare the long-term clinical parameters between pre- and post-dilution online HDF with the reuse dialyzer.
Material and Method: This 2-year historical cohort study was conducted in 20 chronic hemodialysis patients who had
undergone thrice-a-week pre-dilution online HDF for at least one year. The patients were switched to post-dilution online
HDF for another year. Reuse dialyzers were utilized in both methods.
Results : No pyrogenic reactions had been detected throughout the 2-year study period. The C-reactive protein (CRP) and
nutritional parameters were in good normal ranges. The normalization of protein equivalent of nitrogen appearance (nPNA)
was significantly higher during the post-dilution period (1.25 + 0.22 vs. 1.11 + 0.14 g/kg/d, p < 0.01). Regarding adequacy
of hemodialysis, the post-dilution online HDF showed significantly better Kt/V than the pre-dilution mode (2.46 + 0.35 vs.
2.35 + 0.35, p < 0.05) whereas the predialysis β2-microglobulin levels were not different (23.43 + 5.35 vs. 23.73 + 5.55 mg/L,
NS). The numbers of reuse were comparable (17.3 + 2.6 vs. 16.4 + 2.7, NS).
Conclusion : Utilizing reuse dialyzer in online HDF could provide efficacy, safety, cost saving, and environmental benefit.
The post-dilution technique yielded the better adequacy and nutritional status without causing the limitation in the reuse
number and would be the standard mode-of-choice for online HDF.
Keywords : Reuse dialyzer, Pre-dilution, Post-dilution, Online hemodiafiltration
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