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Introduction: Currently, on-line hemodiafiltration (HDF-OL) is the most effective technique. Several randomized studies and meta-analyses have shown a reduced mortality and a direct association with convective volume has been reported. At present, it has not been established if an increased dialysate flow (Qd) results in improved results in terms of convective and depurative efficiency. We aim at assessing the effects of Qd variations on convective volume and its depurative capacity in patients on HDF-OL., Material and Methods: A total of 59 patients (45 men and 14 women) from a HDF-OL programme in which a monitor 5008 Cordiax with self-replacement was used, were enrolled. Patients were assessed in 5 sessions with post-dilutional HDF-OL, using helixone-based dialyzers, with only Qd being changed (300, 400, 500, 600 and 700ml/min). Serum levels of urea (60Da), creatinine (113 Da), β2-microglobulin (11,800Da), myoglobin (17,200Da) and α1-microglobulin (33,000Da) were measured at the beginning and at the end of each session, in order to estimate the percent reduction of such solutes., Results: An increased dialysate volume per session was observed, from 117.9±6.4 L with Qd 300ml/min to 232.4±12 L with Qd 700ml/min. No changes were found in replacement volume or convective volume. Regarding diffusion, Qd increase was associated to a significantly increased dialysis dose, with an increased Kt from 68±6.9 L with Qd 300ml/min to 75.5±7.3 L with Qd 700ml/min (p<0,001), and a gradually increased percent reduction in urea associated to increased Qd with significantly lower levels being found with Qd 300ml/min. No changes were found in other measured substances., Conclusion: Qd variations in HDF-OL do not change convective volume. A higher Qd was associated to a slightly increased urea clearance with no change being observed for medium and large molecules. Qd optimisation to the minimal level assuring an adequate dialysis dose and allowing water and dialysate use to be rationalised should be recommended., (Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Online hemodiafiltration (OL-HDF) is currently the most effective technique. Several randomized studies and meta-analyses have observed a reduction in mortality as well as a direct association with convective volume. Currently, it has not been well established whether a larger dialyzer surface area could provide better results in terms of convective and depurative effectiveness. The aim of this study was to assess the effect of larger dialyzer surface areas on convective volume and filtration capacity., Material and Methods: A total of 37 patients were studied, including 31 men and 6 women, who were in the OL-HDF program using a 5008 Cordiax monitor with auto-substitution. Each patient was analyzed in 3 sessions in which only the dialyzer surface area varied (1.0, 1.4 or 1.8 m(2)). The concentrations of urea (60 Da), creatinine (113 Da), β2-microglobulin (11800 Da), myoglobin (17200 Da) and α1-microglobulin (33000 Da) were determined in serum at the beginning and end of each session in order to calculate the percent reduction of these solutes., Results: The convective volume reached was 29.8 ± 3.0 with 1.0 m(2), 32.7 ± 3.1 (an increase of 6%) with 1.4 m(2), and 34.7 ± 3.3 L (an increase of 16%) with 1.8 m(2) (p<.001). The increased surface of the dialyzer showed an increase in the dialysis dose as well as urea and creatinine filtration. The percentage of β2m reduction increased from 80.0 ± 5.6 with 1.0 m(2) to 83.2 ± 4.2 with 1.4 m(2) and to 84.3 ± 4.0% with 1.8 m(2). As for myoglobin and a1-microglobulin, significant differences were observed between smaller surface area (1.0 m(2)) 65.6 ± 11 and 20.1 ± 9.3 and the other two surface areas, which were 70.0 ± 8.1 and 24.1 ± 7.1 (1.4 m(2)) and 72.3 ± 8.7 and 28.6 ± 12 (1.8 m(2))., Conclusion: The 40% and 80% increases in surface area led to increased convective volumes of 6 and 16% respectively, while showing minimal differences in both the convective volume as well as the filtration capacity when the CUF was higher than 45 ml/h/mmHg. It is recommended to optimize the performance of dialyzers with the minimal surface area possible when adjusting the treatment prescription., (Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: On-line haemodiafiltration (OL-HDF) is based on the controlled administration of large volumes of replacement ultrapure dialysate to the extracorporeal blood circuit of dialysis. It is currently the most effective technique for eliminating small and large uraemic toxins. Recent studies have observed a direct association between a decrease in mortality and the received convective volume. The latest Fresenius 5008 (5008 CorDiax) monitor software update enables the automation of the replacement volume without requiring total protein and haematocrit values, with the aim of maximising convection., Objective: The study&rsquo;s objective was to evaluate the recent version of the 5008 monitor software, compared to the previous version, on the impact on total convective volume., Material and Method: We included 63 patients (44 males and 19 females), with a mean age of 65.2&nbsp;&plusmn;&nbsp;15 years, on OL-HDF. Each patient was analysed in 6 sessions; 3 with the 5008 monitor and 3 with the 5008 CorDiax monitor. The replacement volume, total convective volume and dialysis parameters were determined in each session., Results: No significant differences were observed in blood, venous or transmembrane pressure, nor was there an increase in the number of alarms or coagulation of lines or dialysers. A significant increase of replacement fluid volume, from 27.2 to 31.2&nbsp;L/session, was observed using the CorDiax software. Total convective volume increased from 29.5 to 33.3 L/session, representing an effective convective volume increase from 26&nbsp;% to 29.6&nbsp;% of total filtered blood., Conclusion: The 5008 dialysis monitor software update has meant a 13&nbsp;% increase of total convective volume and a 3.5&nbsp;% increase of total filtered blood.

Unlabelled: Calcium is one of the key elements to consider in patients on dialysis due to its relationship with cardiovascular risk. The introduction of non-calcium-based phosphate binders and calcimimetics has changed the setting for pre-dialysis serum calcium in recent years from 9.5-10.5mg/dl to 8.5-9.5mg/dl. To assess more accurately the changes in calcium (Ca) during haemodialysis sessions and to individualise prescriptions, the aim of this study was to assess the intradialytic changes of two different dialysate Ca concentrations before and after hemodialysis and their implications in controlling calcium-phosphate metabolism., Patients and Method: We analysed 98 patients with a mean age of 59.3 ± 15 years, 68 of which were men and 30 women. Each patient received two HD sessions with two different dialysate Ca concentrations: 2.5 mEq/l (Ca25 group) or 3.0 mEq/l (Ca30 group). Pre- and post-dialysis Ca, phosphorus (P) and PTH were determined, and associated medications were recorded. For a more individualised analysis, patients were divided into four subgroups of Ca<8.5mg/dl, 8.5-9.0mg/dl, 9.0-9.5mg/dl, and >9.5mg/dl, according to pre-dialysis serum calcium levels., Results: There were no differences in pre-dialysis values of Ca: 8.81 ± 0.65 (CA25) and 8.88 ± 0.61 (CA30), P: 4.01 ± 1.3 (CA25) and 4.19 ± 1.2 (CA30), or PTH: 352 ± 288 (CA25) and 369 ± 310 (CA30). Post-dialysis Ca and PTH did not change significantly with CA25 dialysate, although there was a significant post-dialysis Ca increase to 10.2 ± 0.6 (P<.001) accompanied by a decrease in post-dialysis PTH (181 ± 227, P<.001) with CA30. However, with CA25 dialysate, when different subgroups of pre-dialysis Ca were analysed: <8.5mg/dl (30.6%), 8.5-9.0mg/dl (31.6%), 9.1-9.5mg/dl (23.5%) and >9.5mg/dl (14.3%) we observed a Ca increase during the session in the <8.5 (P<.001) and 8.5-9.0 (P<.01) subgroups. Ca was unchanged in the 9.1-9.5 group and Ca decreased when the initial Ca values were >9.5mg/dL (P<.01). A Ca increase (P<.001) and a decrease in PTH (P<.01) were observed in all subgroups with CA30 dialysate. A total of 42% of patients were taking calcimimetics, 47% paricalcitol, and 32% calcium-based phosphate binders, although these drugs were not linked with pre- or post-dialysis Ca levels in or dialysate treatment., Conclusion: We concluded that the prescription of Ca dialysate needs to be individualised based on pre- and post-dialysis Ca values and the need for an increase, decrease, or no changes in post-dialysis calcium in relation to the clinical condition of the patient's phosphorous-calcium metabolism.

Objective: The risk for tuberculosis (TB) is increased in patients with chronic renal failure and dialysis. Tuberculin skin test (TST) is the classical diagnostic method for screening despite its low sensitivity. New methods based on interferon-gamma have been developed. The aim of this study was to evaluate if Quantiferon® TB-gold In Tube (QFT-GIT) could be useful in the diagnosis of TB infection in patients on peritoneal dialysis (PD)., Patients and Methods: Fifty-four patients on PD were included in the study. They were evaluated for latent tuberculosis with QFT-GIT, TST and an assessment by an expert pulmonologist using patient's medical history and x-rays. Agreement between test results was determined., Results: The prevalence of a positive TST was 29.6% for the first test and 31.5% for the second (booster effect). A positive chest x-ray increased the rate of detection of patients with latent TB infection up to 42.6% and the expert physician's evaluation to 44.4%. The correlation between QFT-GIT and TST was fair (k=0.36; P=.006), as it was between TST and expert physician's evaluation (k=0.257; P=.06)., Conclusions: According to our experience QFT-GIT represents an important advantage in the diagnosis of latent TB infection in chronic renal failure patients on PD. It may complement but not replace TST.