Nihon Toseki Igakkai Zasshi
Online ISSN : 1883-082X
Print ISSN : 1340-3451
ISSN-L : 1340-3451
Clinical assessment of intermittent infusion hemodialysis (I-HD) using backfiltration of ultrapure dialysis fluid by an automated dialysis machine
Kei EguchiMasaki MiyaoYushi YamadaYoshie KonnoIwakazu KanekoMichio MineshimaMasahiro TaokaTakashi SatoYuichi HagiharaHiroyuki MichiwakiRika HanabusaYoko HosotaniTomohiro TaoKenji TsuchidaJun MinakuchiTomohiko TanigawaTeruhiko MiyamotoMisaki MoriishiHideki KawanishiAkio NakagawaKanako IwakumaTomokazu YoshidaYoko ImaiHideto ObataTetsuya Matsushima
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2009 Volume 42 Issue 9 Pages 695-703

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Abstract
During a typical hemodialysis (HD) treatment, excessive water removal often induces hypotension and muscle spasm, thereby leading to peripheral circulatory failure. Intermittent infusion hemodialysis (I-HD) using backfiltration of ultrapure dialysis fluid produced by an automated dialysis machine, GC-110N (JMS Co. Ltd., (Town), Japan) was newly developed to improve the physical condition of patients. I-HD may therefore transiently improve the peripheral circulation by repeated intermittent infusion. The aims of this modality are : (1) improving the blood flow condition ; (2) enhancing extravascular to intravascular water transfer ; and (3) improving the efficacy of solute removal from the intracellular compartment. A multi-center clinical trial was carried out to evaluate the clinical effectiveness of the I-HD therapy in comparison with normal HD (N-HD). We enrolled 20 chronic renal disease patients in this cross-over study of I-HD and N-HD. I-HD includes the intermittent infusion (rapid infusion at a rate of 200-300 mL per occasion of infusion ; 7-10 times per treatment) and changes in the amplitude of the patient's circulatory blood flow volume must be maintained within approximately 5%. The values for removal rate (RR), solute clearance (CL) and clear space (CS) for urea, creatinine, uric acid, inorganic phosphate, β2-microglobulin (β2-MG) and α1-microglobulin (α1-MG) were compared between I-HD and N-HD therapies. Time course of blood volume (BV) and peripheral blood flow rate of the patient were measured continuously by a hematocrit monitor and laser flowmeter, respectively. As a result, increases of BV and peripheral blood flow rate were observed for each infusion in all patients. Time-averaged BV reduction during treatment was significantly lower in the I-HD than in the N-HD, despite removal of almost an identical amount of water. Although there was no significant difference in the RR for all solutes between I-HD and N-HD, the average of CS values in I-HD was higher than those in N-HD for all solutes. In particular, I-HD showed significantly higher CS values for inorganic phosphate and α1-MG than N-HD. Improvement of peripheral circulation due to intermittent infusion might be increased in extravascular to intravascular water transfer and solute transport from the intracellular compartment. From 1 to 4 hours after the start of treatment, α1-MG CL deterioration with time in the N-HD and the I-HD were 73% and 30%, respectively. Moderate reduction of CL in I-HD was due to the prevention of membrane fouling by intermittent backfiltration of the dialysis fluid. The validity of I-HD therapy using GC-110N was clarified on the basis of these observations and results during the clinical trial. Therefore, improvement of peripheral circulation and solute removal from the extravascular compartment for relatively larger molecular weight substances were observed in I-HD by enhanced plasma refilling.
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© 2009 The Japanese Society for Dialysis Therapy
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