Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study

نویسندگان

  • Francesco Locatelli
  • Sergio Stefoni
  • Thierry Petitclerc
  • Luigi Colì
  • Salvatore Di Filippo
  • Simeone Andrulli
  • Christine Fumeron
  • Giovanni Maria Frascà
  • Sibilla Sagripanti
  • Silvana Savoldi
  • Andrea Serra
  • Carmine Stallone
  • Filippo Aucella
  • Antonio Gesuete
  • Antonio Scarlatella
  • Francesco Quarello
  • Paola Mesiano
  • Peter Ahrenholz
  • Roland Winkler
  • Lise Mandart
  • Joan Fort
  • Christian Tielemans
  • Carlo Navino
چکیده

BACKGROUND Intradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH. METHODS Fifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment. HFR-Aequilibrium (HFR-Aeq) is an evolution of the haemofiltration with endogenous reinfusion (HFR) dialysis therapy, with dialysate sodium concentration and ultrafiltration rate profiles elaborated by an automated procedure. The primary end point was the frequency of IDH. RESULTS Symptomatic hypotension episodes were significantly lower on HFR-Aeq versus HFR (23 ± 3 versus 31 ± 4% of sessions, respectively, P l= l0.03), as was the per cent of clinical interventions (17 ± 3% of sessions with almost one intervention on HFR-Aeq versus 22 ± 2% on HFR, P <0.01). In a post-hoc analysis, the effect of HFR-Aeq was greater on more unstable patients (35 ± 3% of sessions with hypotension on HFR-Aeq versus 71 ± 3% on HFR, P <0.001). No clinical or biochemical signs of Na/water overload were registered during the treatment with HFR-Aeq. CONCLUSIONS HFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na(+) measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

تاثیر تمرین ورزشی هوازی تناوبی حین همودیالیز بر سطح پلاسمایی هموسیستئین و عملکرد بدنی بیماران همودیالیزی

Background and Objective: Increased homocysteine levels resulting from renal failure and physical inactivity in hemodialysis patients can put them at risk for cardiovascular diseases. On the other hand, exercise training may have a favorable effect on homocysteine levels and physical performance in these patients. Therefore, the aim of the present study was to investigate the effect of eight we...

متن کامل

Efficacy of Biofeedback Therapy before and after Sphincteroplasty for Fecal Incontinence because of Obstetric Injury: A Randomized Controlled Trial

Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence.The present randomized controlled trial was performed on 27 women with a c...

متن کامل

Acetate-free biofiltration reduces intradialytic hypotension: a European multicenter randomized controlled trial.

BACKGROUND Intradialytic hypotension (IH) is a common complication of bicarbonate hemodialysis (BD) and contributes to the intolerance of dialysis and the high cardiovascular morbidity and mortality among dialysis patients, the risk of which can be contained by convective therapies. AIMS/METHODS To assess whether acetate-free biofiltration (AFB), a hemodiafiltration technique found to improve...

متن کامل

Effects of acetate-free haemodiafiltration (HDF) with endogenous reinfusion (HFR) on cardiac troponin levels.

BACKGROUND Haemofiltrate reinfusion (HFR) is a form of haemodiafiltration (HDF) in which replacement fluid is constituted by ultrafiltrate from the patient 'regenerated' through a cartridge containing hydrophobic styrene resin. Bicarbonate-based dialysis solutions (DS) used in routine haemodialysis and HDF contain small quantities of acetate (3-5 mMol/L) as stabilizing agent, one of the major c...

متن کامل

Vitamins (A, C and E) and oxidative status of hemodialysis patients treated with HFR and HFR-Supra

BACKGROUND Hemodiafiltration with on-line endogenous reinfusion (HFR) is an extracorporeal dialytic method that combines diffusion, convection and adsorption. HFR-Supra (HFR-S) is a second-generation system with increased convective permeability and adsorption capability. Previous studies suggested that HFR reduces oxidative stress compared to standard haemodialysis. The principal aim of the pr...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 27  شماره 

صفحات  -

تاریخ انتشار 2012