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With the aim of treating with short sessions even chronic uremic patients with cardiovascular instability, we have developed our previous findings about paired filtration dialysis (hemofiltration-hemodialysis in series) by a method we call high-efficiency paired filtration dialysis (HEPFD). We have treated with this method for 6 months 6 chronic anuric uremic patients previously treated for 6 months with hemofiltration (HF) because of their cardiovascular instability. By comparison with HF, HEPFD shows much higher clearances of small molecules with consequent significant decrease of their predialytic values, improvement of Kt/V value, lower beta 2-microglobulin clearance (its predialytic value remains unchanged), and the same tolerability. HEPFD allows short, efficient, and well-tolerated treatments even in patients with cardiovascular instability.

Levels of plasma lipids and the fatty acid composition of major plasma lipid classes have been determined in chronically uremic patients before and after treatments with hemofiltration, high efficiency paired filtration dialysis, or acetate-free biofiltration. The major findings are a decrease of triglycerides and an increase of total free fatty acids (FFAs) at the end of the dialytic session--already reported in the literature--that do not appear to be strictly dependent on heparin administration. The changes in the plasma concentrations of selected saturated and polyunsaturated fatty acids, which may contribute to alteration of functional parameters in the cardiovascular system in dialyzed patients, are different in the various types of techniques.

In this study, 6 chronic anuric uremic patients underwent lactate hemofiltration (HF) with a substitution fluid, prepared in bags, for 3 months and bicarbonate HF, with continuous on-line preparation of the substitution fluid, for 3 months. We determined Na+, Cl-, K+, total calcium (Ca), ionized calcium (Ca2+), phosphate, intact parathormone (I-PTH), pH, Pco2, Po2, and HCO3- in plasma before, during, and after the treatment, as well as Ca, Ca2+, phosphate, and I-PTH in the ultrafiltrate. Moreover, heart rate (HR) and mean arterial pressure (MAP) were continually recorded during the procedure. Furthermore, the patients underwent echocardiographic study before and after the session. In comparison with lactate, bicarbonate HF caused a significant increase in HCO3- and a decrease in K+ plasma concentrations. This was detectable, with lower significance, even 44 h after the end of the treatment. At the end of the long interdialytic period (68 h after the end of the treatment), no significant difference was detectable. pH and Pco2 showed a significant but transient increase during HF. The other parameters investigated did not differ significantly between the two methods.