Technical and Clinical Data on High-Performance Hemofiltration: Twelve Patients During One Year

In 12 chronic hemodialysis patients, postdilutional hemofiltration (HF) was substituted for conventional acetate hemodialysis (HD) (4-5 h/session with high-area capillary dialyzers). In HF, the purposes were to obtain (a) no increase in pre-HF uremia compared with pre-HD uremia (high ultrafiltrate volume), (b) an HF duration shorter than that of HD (mean ultrafiltrate rate greater than 120 ml/min), (c) a disposable cost of an HF session identical to that of an HD session (reuse of hemofilters and extemporaneous preparation of substitution fluid). One-year results were (a) an ultrafiltrate volume of 26.8 L/session and a pre-HF uremia of 35.4 mmol/L (pre-HD uremia 34.0 mmol/L), (b) a mean ultrafiltrate rate of 143 ml/min and a mean HF duration of 190 min (mean HD session duration 250 min), and (c) better clinical tolerance and vascular stability in HF than in HD (weight loss 3.5 kg in HF and 3.0 kg in HD). Reuse of filters and extemporaneous preparation of substitution fluid were not responsible for any pyrogen reaction or bacterial contamination. In conclusion, (a) compared with conventional HD, high-flux HF results included identical removal of small molecules, improvement in vascular stability, decrease in session duration, and identical disposable cost; (b) routine high-flux HF is workable in a dialysis unit; (c) vascular access is the most important limiting factor to high-flux HF. Today 30-40% of patients can be treated with this method.