2013 Volume 4 Issue 2 Pages 143-147
Dialysis efficiency of continuous hemodiafiltration (CHDF) basically depends on the amount of dialysate and ultrafiltration flow. Small membrane surface area (MSA) hemofilter is expected to benefit the patients with unstable hemodynamics because of the smaller amount of priming volume, but how the size of MSA contributes to the efficiency and durability of CHDF is still unknown. To elucidate the benefit and the effect of small MSA hemofilter on CHDF in critical settings, we conducted two-story studies. The first step is the preliminary saline-based experiment in vitro to elucidate the determinants of dialysis efficiency. In this study, the amount of dialysate was limited to the extent of the reimbursement. Consequently, we found only the amount of dialysate determine the dialysis efficiency. Thus, neither the size of MSA nor the amount of blood flow was the determinant of the efficiency. Based on the preliminary results, we scrutinized and compared 37 small MSA filter (AEF03, Asahi-kasei Co.Ltd, Tokyo, Japan) and 32 large MSA filter (AEF07 Asahi-Kasei Co.Ltd) used in our Hospital in terms of the life-time and inter-circuit pressure. Consequently, we found the small MSA filter AEF03 comparable to AEF07. According to these two studies, we suggest that AEF03 be less invasive because the former is expected to yield the stabilization of hemodynamics without reducing the dialysis efficiency. We supposed that the benefit of small MSA is attributable to the reduction of priming volume, and blood loss retained by the circuit as well as the exposure time of the blood to the external environment.
