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High-flux hemodialysis (HFHD) is widely used in hemodialysis centers and is the mode of hemodialysis actively recommended by the guidelines. Additionally, hemodiafiltration (HDF) is widely used in clinical practice. However, there are some inconsistencies in the results of studies on the effects of HDF and HFHD, which has caused controversy regarding which of these two dialysis modalities to select. To explore the effect of HFHD and HDF on the survival of patients with end-stage kidney disease (ESKD). A systematic search of the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases was conducted, focusing on cohort studies and randomized controlled trials on hemodialysis in patients with ESKD using HFHD or HDF. A meta-analysis of all-cause mortality and cardiovascular mortality was conducted using Review Manager 5.3 software, and fixed and random effect models were applied according to the heterogeneity results. A total of 13 studies, including six cohort studies and seven randomized controlled trials, were included in the final analysis. The results revealed that HFHD had no statistically significant effect on the all-cause mortality (odds ratio (OR): 1.16, 95% confidence interval (CI): 0.86, 1.57) or cardiovascular mortality (OR: 0.86, 95% CI: 0.64, 1.15) of patients with ESKD. However, compared with HDF, HFHD reduced the infection mortality rate (OR: 0.50, 95% CI: 0.33, 0.77). Compared with HDF, HFHD has no obvious benefits for all-cause mortality or cardiovascular mortality in patients with ESKD, but reduced risk of infection-related death. [ABSTRACT FROM AUTHOR]

AbstractBackground High-flux hemodialysis (HFHD) is widely used in hemodialysis centers and is the mode of hemodialysis actively recommended by the guidelines. Additionally, hemodiafiltration (HDF) is widely used in clinical practice. However, there are some inconsistencies in the results of studies on the effects of HDF and HFHD, which has caused controversy regarding which of these two dialysis modalities to select.Objective To explore the effect of HFHD and HDF on the survival of patients with end-stage kidney disease (ESKD).Methods A systematic search of the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases was conducted, focusing on cohort studies and randomized controlled trials on hemodialysis in patients with ESKD using HFHD or HDF. A meta-analysis of all-cause mortality and cardiovascular mortality was conducted using Review Manager 5.3 software, and fixed and random effect models were applied according to the heterogeneity results.Results A total of 13 studies, including six cohort studies and seven randomized controlled trials, were included in the final analysis. The results revealed that HFHD had no statistically significant effect on the all-cause mortality (odds ratio (OR): 1.16, 95% confidence interval (CI): 0.86, 1.57) or cardiovascular mortality (OR: 0.86, 95% CI: 0.64, 1.15) of patients with ESKD. However, compared with HDF, HFHD reduced the infection mortality rate (OR: 0.50, 95% CI: 0.33, 0.77).Conclusions Compared with HDF, HFHD has no obvious benefits for all-cause mortality or cardiovascular mortality in patients with ESKD, but reduced risk of infection-related death.

Background: Whereas most studies to date have mainly concentrated on the comparison between high‐flux hemodialysis (HFHD) and hemodiafiltration (HDF), or HFHD and low‐flux hemodialysis (LFHD) in relation to the clearance of β2‐microglobulin (β2M) in HD patients, there have been few related to combined HFHD and HDF therapy. To compare the clearance of middle‐sized molecules as measured by β2M in HFHD versus LFHD and HDF. Methods: A prospective, single‐center, open‐label, observer‐blinded, randomized controlled trial was conducted at the West China Hospital of Sichuan University in China. Patients received either HFHD or LFHD and HDF 3 times a week with follow‐ups at one and 3 months. The primary endpoint was the clearance of β2M at 3 months. The secondary endpoints included hemodialysis‐related adverse events, changes in anemia, states of nutrition, and inflammatory indices. Results: After 3 months of treatment, the HFHD+HDF group achieved a higher satisfaction level than the LFHD+HDF group, with decreased serum β2M concentrations (34.493 ± 7.257 vs. 43.593 ± 9.036 mg/L, p < 0.001) and elevated red blood cell counts (3.959 ± 0.742 vs. 3.602 ± 0.578 × 1012/L, p = 0.015). Compared with baseline, both kinds of treatment led to increases in serum urea (t = −3.623, p = 0.001 vs. t = −4.240, p < 0.001), cholesterol (t = −2.511, p = 0.016 vs. t = −4.472, p < 0.001), and magnesium (t = −2.648, p = 0.011 vs. t = −3.561, p = 0.001). An elevated level of serum albumin (t = −2.683, p = 0.010) was observed only in the HFHD+HDF group. Conclusions: Combined therapy with HFHD and HDF has a beneficial effect on improving β2M clearance, red blood cell management, and nutrition status in HD patients. [ABSTRACT FROM AUTHOR]

Introduction: Acute kidney injury (AKI) after high dose methotrexate (HD-MTX) is associated with delayed MTX-excretion and life-threatening toxicity. Glucapridase, the recommended therapy, is expensive and not always available. Case series: We describe 3 cases (69, 67, 73 years) with diffuse large B-cell lymphoma who developed AKI and early-onset severely delayed MTX elimination after HD-MTX. MTX serum concentrations were 101 and 69 μmol/L at 24 h after administration in two patients and 34 μmol/L at 32 h in the third. Management and outcome: Since glucarpidase was unavailable, we performed daily high-flux hemodialysis (HF-HD) or online hemodiafiltration (HDF) sessions (median duration, 6 h). The median serum MTX elimination half-life during HDF/HF-HD sessions was similar in all patients (median, 4.4 h; IQR, 3.8–5.3 h), but serum MTX concentrations rebounded after each dialysis by a median of 40% of the trough concentrations. The three patients underwent multiple dialysis sessions, until MTX serum concentrations remained sufficiently low to be neutralized by leucovorin. Only 1 patient developed severe pancytopenia, and renal function normalized in all patients after 3–6 weeks. Discussion: In conclusion, when glucarpidase is unavailable or delayed, early, repeated and prolonged HDF/HF-HD effectively enhance MTX elimination and prevent toxicity in patients with AKI and severely delayed MTX elimination after HD-MTX. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of high-flux hemodialysis (HFD) combined with hemoperfusion (HP) and Edaravone on the levels of toxins, clinical signs and symptoms, sleep quality and negative emotions of patients with uremia restless legs syndrome (RLS). Methods: 174 patients with uremia RLS admitted to the hemodialysis center of our hospital from February 2018 to December 2019 were selected, and the patients were divided into three groups by random number table method. The Routine hemodialysis (HD) group (58 cases) was treated with conventional hemodialysis, the joint group A (58 cases) was treated with HFD combined HP, and the joint group B (58 cases) was treated with HFD combined HP and Edaravone. The differences in renal function[urea nitrogen (BUN),serum creatinine (SCr), urinary albumin excretion rate (UAER)], serum toxin [parathyroid hormone (PTH), indoxyl sulphate (IS), pcresyl sulphate (PCS)]levels, RLS score, sleep quality, negative emotions and adverse reactions in three groups were observed before and after treatment. Results: The levels of serum BUN, SCr, UAER, PTH, IS, PCS, RLS score, Pittsburgh sleep quality index (PSQI) score, Hamilton anxiety scale (HAMA) score and Hamilton depression scale (HAMD) score all decreased after treatment in three groups (P<0.05). The levels of serum BUN, SCr, UAER, PTH, IS, PCS in the joint group A and the joint group B were lower than those of the HD group after treatment (P<0.05), and there was no statistical difference between the joint group A and the joint group B (P>0.05). After treatment, RLS score, PSQI score, HAMA score and HAMD score in the joint group B were all lower than those in the joint group A and the HD group (P<0.05), while those in the joint group A were lower than those in the HD group (P<0.05). There was no significant difference in the incidence of adverse reactions in the three groups (P>0.05). Conclusion: HFD combined with HP and edaravone can improve the clinical symptoms and renal function of uremic RLS patients, reduce serum toxin level, and improve sleep quality and negative emotions. [ABSTRACT FROM AUTHOR]

Expanded hemodialysis (HDx) has a high capacity for removing medium and medium‐large molecules; however, there are no specific recommendations during HDx for anticoagulation of the dialysis circuit. We aimed to evaluate the differences in the efficacy of anticoagulation procedures using the venous port and 40 mg enoxaparin in HDx compared to high‐flux hemodialysis (HF‐HD) and postdilution online hemodiafiltration (HDF). We compared anticoagulant activity in 11 patients in HDx, HF‐HD, and HDF under similar dialysis conditions. In the 33 dialysis sessions, 40 mg enoxaparin was administered through the venous port, and pre‐ and postdialysis antifactor Xa activity (aXa) and activated partial thromboplastin time (APTT), postdialysis clotting time of the vascular access, visual clotting score of the dialyzer, and any complications with the extracorporeal circuit or bleeding were registered. APTT postdialysis in HDx was not significantly different from that in HF‐HD and HDF. Postdialysis aXa in HDx was not significantly different from that in HF‐HD and HDF. We found no significant differences in visual clotting score of the dialyzer. Enoxaparin administered through the venous port was sufficient for anticoagulation within the extracorporeal circuit in HDx, HF‐HD, and HDF. There were no differences in postdialysis aXa or APTT, most likely because when low molecular–weight heparin is applied through venous port, lesser enoxaparin concentration reaches the dialyzer. Thus, we conclude that the dose of enoxaparin administered through the venous port should not be adjusted according to dialysis technique. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to explore the effect of changing treatment to high-flux hemodialysis (HFHD) on mortality rate in patients with long-term low flux hemodialysis (LFHD). Methods The patients with end-stage renal disease (ESRD) who underwent LFHD with dialysis age more than 36 months and stable condition in our hospital before December 31, 2014 were included in this study. They were divided into control group and observation group. Propensity score matched method was used to select patients in the control group. The hemodialysis was performed 3 times a week for 4 h. The deadline for follow-up is December 31, 2018. End-point event is all-cause death. The survival rates of the two groups were compared and multivariate Cox regression analysis was carried out. Results K-M survival analysis showed that the 1-year, 2-year, 3-year and 4-year survival rates of HFHD group were 98, 96, 96 and 96%, respectively. The 1-year, 2-year, 3-year and 4-year survival rates of LFHD group were 95, 85, 80 and 78%, respectively. Log-rank test showed that the survival rate of HFHD group was significantly higher than that of LFHD group (x2= 7.278, P = 0.007). Multivariate Cox regression analysis showed that male, age, hemoglobin and low-throughput dialysis were independent predictors of death (P

Abstract Background Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing. Methods We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days. Results Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p

Background: Dialysis therapy has remarkably evolved through the innovation in dialyzers and hemodialysis modalities, enhancing patients' quality of life. The efficacy of dialysis can be determined by measuring the reduction ratio (RR) of middle molecules, such as alpha 1-microglobulin (A1M). Objectives: In our study, we tested a high-flux dialyzer, BIOPURE (Biorema) 260 HF, with a surface area (SA) of 2.6 m2, in terms of A1M removal and concurrent albumin loss in dialysate while receiving high-flux hemodialysis (HF-HD) and post-dilution online hemodiafiltration (OL-HDF). Patients and Methods: This crossover study comprised 25 patients who received a session of HF-HD using the BIOPURE (Biorema) 260 H, followed by a session of post-dilution OL-HDF. A washout period of 2 weeks was instilled between the two sessions, during which the patients received HF-HD using high-flux dialyzers (maximum SA 2.0 m2). All patients' hourly dialysate albumin and pre/post dialysis concentrations of A1M were measured. Results: The dialyzer used in this study resulted in an A1M RR of 41.967.93% (p < 0.001) with HDF and 27.1267.65% (p < 0.001) with HF-HD; and a median cumulative dialysate albumin loss of 2.97g (IQR 1.98 - 3.37) with HDF, and 0.67g (IQR 0.49 - 1.13) with HF-HD. Conclusion: The dialyzer BIOPURE (Biorema) 260 HF (SA 2.6 m2) is efficient in eliminating A1M, especially with OL-HDF compared to HF-HD, with acceptable albumin loss in the dialysate. [ABSTRACT FROM AUTHOR]

Background/Aims: Studies on the long-term clinical benefits of hemodiafiltration (HDF) and high-flux hemodialysis (HFHD) are very limited. This study aimed to investigate the hospitalization rate and aortic arch calcification (AAC) of these two dialysis modalities over 6 years. Methods: Participants who received regular HDF and HFHD in one hospital-facilitated hemodialysis center were prospectively enrolled after matching for age, sex, and diabetes between January 2009 and December 2014. Medical records were reviewed retrospectively on demographics, laboratory variables, calcified scores in aortic arch measured by chest radiography, and rates of hospital admission. Cox proportional hazard regression and linear regression were used to obtain the outcome results. Results: The HDF and HFHD groups consisted of 108 and 102 participants, respectively. Levels of laboratory variables including small soluble solutes and Kt/V were not statistically different over the 6-year period between the HDF and HFHD groups. Calcified scores of the aortic arch increased over 6 years in both groups. The changes in the mean calcified scores were significant when compared between the two groups (0.44–1.82 in HFHD, 0.79–1.8 in HDF, respectively, p = 0.008). Hospitalization rates were 735 per 1,000 patients in the HDF group and 852 per 1,000 patients in the HFHD group, respectively. No significant difference was observed in frequency and days of hospitalization between HDF and HFHD. Conclusion: Hospitalization rates and AAC were observed to be equal for HDF and HFHD.

Renal Replacement Therapies generally associated to the Artificial Kidney (AK) are membrane-based treatments that assure the separation functions of the failing kidney in extracorporeal blood circulation. Their progress from conventional hemodialysis towards high-flux hemodialysis (HFHD) through the introduction of ultrafiltration membranes characterized by high convective permeation fluxes intensified the need of elucidating the effect of the membrane fluid removal rates on the increase of the potentially blood-traumatizing shear stresses developed adjacently to the membrane. The AK surrogate consisting of two-compartments separated by an ultrafiltration membrane is set to have water circulation in the upper chamber mimicking the blood flow rates and the membrane fluid removal rates typical of HFHD. Pressure drop mirrors the shear stresses quantification and the modification of the velocities profiles. The increase on pressure drop when comparing flows in slits with a permeable membrane and an impermeable wall is ca. 512% and 576% for $ \mathrm{CA}22/5\%{\mathrm{SiO}}_2 $ and $ \mathrm{CA}30/5\%{\mathrm{SiO}}_2 $ membranes, respectively.

Blood flow (Qb) is one of the dialysis parameters most strongly influencing the performance of dialysis modalities. However, few studies have compared different dialysis modalities in patients with low Qb. We conducted a prospective, single‐center study in 21 patients. Each patient underwent four dialysis sessions with routine dialysis parameters: high‐flux hemodialysis (HD), predilution hemodiafiltration (pre‐HDF), expanded HD (HDx), and postdilution HDF (post‐HDF). The removal ratios (RR) of urea, creatinine, ß2‐microglobulin, myoglobin, prolactin, α1‐microglobulin, free kappa and lambda immunoglobulin light chains (ķFLC and λFLC), α1‐acid glycoprotein, and albumin were compared intraindividually. A proportional part of the dialysate was collected to quantify albumin loss. There were no differences in urea and creatinine RRs. The β2‐microglobulin RR was higher in pre‐HDF and post‐HDF. Myoglobin and prolactin RRs were higher with HDx and post‐HDF. The α1‐microglobulin and α1‐acid glycoprotein RRs were significantly higher with post‐HDF than with other treatments, and RRs obtained with HDx were higher than obtained with HD and pre‐HDF. Free ķFLC and λFLC RRs showed the following results in ascending order: HD, pre‐HDF, HDx, and post‐HDF, most of them with statistical significance. Albumin loss varied from 0.45 g with HD to 3.5 g with post‐HDF. The global removal score values were 41.0 ± 4.8% with HD, 44.0 ± 5.2% with pre‐HDF, 49.5 ± 4.6% with HDx, and 54.8 ± 5.3% with post‐HDF, with significant differences between all treatment modalities. In conclusion, this study confirms the superiority of post‐HDF over high‐flux HD, pre‐HDF, and HDx in patients with low Qb. HDx was the closest alternative to post‐HDF and was clearly superior to HD and pre‐HDF. Finally, pre‐HDF was also superior to HD. With this Qb, there was a higher risk of underdialysis, both diffusive and convective, especially in patients with a session duration of less than 5 h. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing.Methods: We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days.Results: Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days.Conclusions: PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments.Trial Registration: HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161). [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the differences between vancomycin clearance (Kd) with high‐flux hemodialysis (HFHD) and on‐line hemodiafiltration (OL‐HDF). The OL‐HDF therapy combined the diffusion and convective transport of solutes. To compare the Kd, a vancomycin loading dose of 1 g was administered intravenously post‐dialysis to 11 chronic and anuric (<100 mL/24 h) hemodialysis patients, undergoing HFHD and post‐dilutional OL‐HDF in consecutive therapies. Additional doses of 0.5 g were administered after 45 minutes at the end of each dialysis therapy during antibiotic treatment. Blood samples were drawn from arterial and venous lines at the start of hemodialysis sessions and at the first, second, third, and fourth hours. Additional samples were drawn at 15, 30, and 45 minutes after the end of dialysis therapy. Vancomycin plasma concentration, blood urea nitrogen (BUN), creatinine, and β2‐microglobulin were measured. The patients' hydration status was evaluated by bioimpedance analysis. The mean of vancomycin dialyzer clearance (Kddc) calculated was 110.8 ± 15 mL/min with HFHD and 146.8 ± 13.8 mL/min with OL‐HDF (P = 0.025). Significant differences were also obtained for β2‐microglobulin clearance, Kddc 72.6 ± 15.4 mL/min with HFHD and 113.4 ± 24.2 mL/min with OL‐HDF (P = 0.012), whereas no differences were found for BUN or creatinine. Additionally, to analyze differences between HFHD and OL‐HDF, a variable volume dual pool mathematical model was developed to estimate the body clearance (Kdbc), extraction mass (Me), and inter‐compartment mass‐transfer coefficient (K12) of each molecule. A higher vancomycin Kddc with OL‐HDF produced by convection improved removal of antibiotic; this can compromise achieving a therapeutic concentration target. We recommended evaluating increased loading doses of vancomycin and avoiding administration during OL‐HDF to assure adequate treatment. [ABSTRACT FROM AUTHOR]

Background/Aims: Studies on the long-term clinical benefits of hemodiafiltration (HDF) and high-flux hemodialysis (HFHD) are very limited. This study aimed to investigate the hospitalization rate and aortic arch calcification (AAC) of these two dialysis modalities over 6 years. Methods: Participants who received regular HDF and HFHD in one hospital-facilitated hemodialysis center were prospectively enrolled after matching for age, sex, and diabetes between January 2009 and December 2014. Medical records were reviewed retrospectively on demographics, laboratory variables, calcified scores in aortic arch measured by chest radiography, and rates of hospital admission. Cox proportional hazard regression and linear regression were used to obtain the outcome results. Results: The HDF and HFHD groups consisted of 108 and 102 participants, respectively. Levels of laboratory variables including small soluble solutes and Kt/V were not statistically different over the 6-year period between the HDF and HFHD groups. Calcified scores of the aortic arch increased over 6 years in both groups. The changes in the mean calcified scores were significant when compared between the two groups (0.44–1.82 in HFHD, 0.79–1.8 in HDF, respectively, p = 0.008). Hospitalization rates were 735 per 1,000 patients in the HDF group and 852 per 1,000 patients in the HFHD group, respectively. No significant difference was observed in frequency and days of hospitalization between HDF and HFHD. Conclusion: Hospitalization rates and AAC were observed to be equal for HDF and HFHD. [ABSTRACT FROM AUTHOR]

Background. Recent meta-analyses suggest that higher removal of beta-2 microglobulin (β2M) with either high-flux (HFD) dialysis or hemodiafiltration (HDF) may be associated with decreased total and cardiovascular mortality in dialysis patients. However, there are limited data about the performance of high flux dialyzers and/or convective therapies in removing β2M. Methods. This is a random effects meta-analysis and metaregression of data extracted from randomized controlled trials and observational studies in hemodialysis, hemofiltration and HDF regarding the efficiency of high flux dialyzers to remove β2M. Studies were searched using ProQuest in SCOPUS, EMBASE and MEDLINE. Results. We included 69 studies from1 January 2001 to 12 June 2017 on 1879 patients with 6771 available measurements. Average β2M clearance was 48.75mL/min [95% confidence interval (CI) 42.50-55.21] for conventional HF dialysis, and 87.06mL/min (95% CI 75.08-99.03) for convective therapies (hemofiltration and HDF) with substantial heterogeneity among studies [P (Q) ≤ 0.001]. Inmultivariable meta-regression analyses, we found significantly higher β2M clearance for polyarylethersulfone dialyzers when used for HFD and polysulfone membranes in convective therapies. However, the mass of β2M removed into the dialysate did not depend on membrane material. Adjusted dialysate-side (-22.279, 95% CI -9.8 to -34.757, P<0.001) β2M clearances were significantly lower than whole blood clearances, suggesting that adsorption contributes substantially to β2M removal. Higher Kuf, blood flow and substitution fluid rates but not dialysate flow rates were associated with statistically significant and clinically meaningful elevation in β2M clearance from the body independent of the dialysis modality. Conclusions. Membrane composition and characteristics, modality (convective versus diffusive), blood flow rates and substitution fluid rates in HDF play a significant role in the efficient removal of β2M from the body in both diffusive and convective dialysis. [ABSTRACT FROM AUTHOR]

Background: Cystatin-C (CyC) is a middle molecule that is freely filtered at the glomerulus and almost completely reabsorbed by the proximal tubules. The aim of this study was to evaluate serum CyC and its reduction ratio as a biomarker for assessing the adequacy of the hemodialysis (HD) sessions in children with end-stage renal disease on maintenance HD. We also compared levels of CyC in patients on low-flux HD (LFH) and high-flux HD (HFH). Methods: Forty patients were included in the study and divided into two groups, with one group (16 patients) receiving HFH and the other group receiving LFH (24 patients) (high-flux and low-flux polysulfone filters, respectively). Before and after each dialysis session serum CyC and beta-2-microglobulin (B2M) levels were measured using an ELISA technique, and routine laboratory tests were performed for each patient. Results: Pre-dialytic levels of CyC were significantly lower in the patients receiving HFH than in those receiving LFH (7.33 ± 1.35 vs. 9.73 ± 0.93, respectively; p < 0.0001). In the HFH group, post-dialytic levels of serum CyC were significantly lower than pre-dialytic levels (4.49 ± 0.71 vs. 7.33 ± 1.35, respectively; p < 0.0001). The reduction ratio (RR) of CyC was significantly higher in the HFH group than in the LFH group (38.2 ± 3.91 vs. −6.49 ± 5.05, respectively; p < 0.0001). Serum CyC level significantly correlated with B2M, urea and creatinine levels in both the LFH and HFH groups, whereas its RR significantly correlated with the RRs of urea, creatinine, and B2M in the HFH group. Conclusion: The results of our study emphasize the role of CyC as a good marker for assessing the adequacy of HD sessions in children on HFH and show that the CyC RR may be used as an index of middle-molecule toxin clearance following HFH sessions. [ABSTRACT FROM AUTHOR]

We investigated the prognostic effects of high-flux hemodialysis (HFHD) and low-flux hemodialysis (LFHD) in patients with chronic kidney disease (CKD). Both an electronic and a manual search were performed based on our rigorous inclusion and exclusion criteria to retrieve high-quality, relevant clinical studies from various scientific literature databases. Comprehensive meta-analysis 2.0 (CMA 2.0) was used for the quantitative analysis. We initially retrieved 227 studies from the database search. Following a multi-step screening process, eight high-quality studies were selected for our meta-analysis. These eight studies included 4967 patients with CKD (2416 patients in the HFHD group, 2551 patients in the LFHD group). The results of our meta-analysis showed that the all-cause death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.704, 95%CI=0.533-0.929, P=0.013). Additionally, the cardiovascular death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.731, 95%CI=0.616-0.866, P

We investigated the prognostic effects of high-flux hemodialysis (HFHD) and low-flux hemodialysis (LFHD) in patients with chronic kidney disease (CKD). Both an electronic and a manual search were performed based on our rigorous inclusion and exclusion criteria to retrieve high-quality, relevant clinical studies from various scientific literature databases. Comprehensive meta-analysis 2.0 (CMA 2.0) was used for the quantitative analysis. We initially retrieved 227 studies from the database search. Following a multi-step screening process, eight high-quality studies were selected for our meta-analysis. These eight studies included 4967 patients with CKD (2416 patients in the HFHD group, 2551 patients in the LFHD group). The results of our meta-analysis showed that the all-cause death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.704, 95%CI=0.533-0.929, P=0.013). Additionally, the cardiovascular death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.731, 95%CI=0.616-0.866, P

Objective: To explore the clinical value of high-flux hemodialysis combined with L-carnitine in treatment of uremia patients with anemia. Methods: 98 uremia patients with anemia accepted in our hospital from January 2013 to March 2015 were selected and divided into observation group with 50 cases and control group with 48 cases. The patients of observation group underwent high-flux hemodialysis combined with L-carnitine, and the patients of control group underwent high-flux hemodialysis only. Then the blood routine examination and biochemical indexes before and after treatment, clinical efficacy and adverse reactions of two groups were observed and compared. Results: The blood routine examination and biochemical indexes before treatment had no statistically significance (P>0.05). The blood routine examination results were increasing after treatment with statistically difference (P<0.05). The Hb and HCT of two groups had no great difference in the month after treatment, but other time and indexes of two groups had statistically significance (P<0. 05). The total efficacy of observation group (86.00 %) was obviously higher than that of control group (68.75 %). The rate of adverse reactions of two groups had no statistically significance (P>0.05). Conclusions: Using high-flux hemodialysis combined with L-carnitine in treatment of uremia patients with anemia has good efficacy and safety, which is worth of clinical application. [ABSTRACT FROM AUTHOR]

Key Clinical Message A young patient develops cerebral posttransplant lymphoproliferative disorder. Despite concurrent significantly impaired transplant kidney function use of add-on high-flux hemodialysis for additional clearance made the administration of high-dose methotrexate feasible in this patient without occurence of acute chronic kidney failure and significant hematological toxicity. [ABSTRACT FROM AUTHOR]

Background: Vancomycin is the antibiotic of choice in therapy of orthopaedic implant infections caused by methicillin-resistant bacteria but its use poses a risk of toxicity, especially in patients with renal insufficiency. Addition of vancomycin to acrylic cement may cause systemic exposition to this drug eluting from cement to serum, which may require high-flux hemodialysis. Methods: A patient hemodialysed twice a week underwent implantation of a spacer due to methicillin-resistant S. epidermidis infection of knee prosthesis. The spacer was made of acrylic cement loaded with 0,55 g of gentamicin per 40 g of cement and 6 g of vancomycin into totally 120 g of cement. The measurements of vancomycin concentration in serum within 9 days and in intraarticular fluid within 2 days were performed. Results: Maximal intraarticular vancomycin concentration was reached 7 hours after surgery ( 120 μg/ mL) and was over Minimal Inhibitory Concentration for 47 hours. The serum concentration reached maximal value (2,6 μg/mL) 13 hours after implantation of spacer and was 2,3 μg/mL on 9-th postoperative day. Conclusion: This composition of acrylic cement spacer containing gentamicin and vancomycin was found therapeutically effective and not necessitating high-flux hemodialysis in a hemodialysed patient with chronic renal failure. [ABSTRACT FROM AUTHOR]

Background Although convective therapies have gained popularity for the optimal removal of uremic solutes, their benefits and potential risks have not been fully elucidated. We conducted a meta-analysis of all randomized controlled trials comparing convective therapies with low-flux hemodialysis in patients with chronic kidney failure. Methods We performed a literature search using MEDLINE (inception-December 2012), Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, scientific abstracts from meetings and bibliographies of retrieved articles. Randomized controlled trials comparing the effect of convective therapies including high-flux hemodialysis, hemofiltration or hemodiafiltration versus low-flux hemodialysis were included. Random-effects model meta-analyses were used to examine continuous and binary outcomes. Results Sixty-five (29 crossover and 36 parallel-arm) trials were identified (n = 12 182). Convective therapies resulted in a decrease in all-cause mortality [relative risk (RR) 0.88; 95% confidence interval (CI) 0.76, 1.02, P = 0.09], cardiovascular mortality (RR 0.84; 95% CI 0.71, 0.98, P = 0.03), all-cause hospitalization (RR 0.91; 95% CI 0.82, 1.01; P = 0.08) and therapy-related hypotension (RR 0.55, 95% CI 0.35, 0.87, P = 0.01). Convective therapies also resulted in an increase in the clearance of several low-molecular-weight (urea, creatinine and phosphate), middle-sized (β-2 microglobulin and leptin) and protein-bound (homocysteine, advanced glycation end-products and pentosidine) solutes and a decrease in inflammatory markers (interleukin-6). There was no impact of convective therapies on cardiac morphological and functional parameters, and blood pressure and anemia parameters. Conclusions Although convective therapies are associated with improved clearance of uremic solutes, the potential long-term benefits of specific convective modalities require further study. [ABSTRACT FROM AUTHOR]

Hypercytokinemia plays a central role in pathogenesis and is related to the high mortality in sepsis-related acute kidney injury ( AKI). Besides the established cytokines, vascular endothelial growth factor ( VEGF) is demonstrated as an important factor in enhancing vascular leakage in sepsis. This prospective randomized trial was conducted to compare the efficacy of cytokine removal between online hemodiafiltration ( HDF), which combines convective and diffusive solute removal, and high-flux hemodialysis ( HD). Twenty-eight sepsis-related AKI patients were included and randomized into online HDF and high-flux HD. The percentages of the reduction ratio in plasma cytokines were measured as primary outcomes. Other clinical parameters were determined as secondary outcomes. When compared with high-flux HD, online HDF provided significantly greater percentages of the reduction ratio in plasma cytokine levels, including VEGF ( P < 0.001), IL-6 ( P = 0.001), IL-8 ( P = 0.021), IL-10 ( P = 0.011), and tumor necrosis factor-α ( P = 0.029). There were no significant differences in intradialytic blood pressures. Online HDF revealed better renal recovery and shorter length of hospitalization than high-flux HD. In conclusion, online HDF in sepsis-related AKI could provide significantly better removal of VEGF and other cytokines and these were associated with better renal outcome than high-flux HD. Thus, online HDF would offer a potential role in hypercytokinemic state in sepsis-related AKI. [ABSTRACT FROM AUTHOR]

Recent years has seen an increasing use of regional citrate anticoagulation in pediatric dialysis. Several approaches have been described for monitoring anticoagulation in the extracorporeal circuit, such as serum citrate levels, post-filter ionized calcium (iCa), and activated coagulation time (ACT). However, no standard recommendations have yet been established for applying any of these parameters, especially for iCa. The objective of this retrospective analysis was to establish adequate coagulation management using post-filter iCa values. Normal values for ACTester-based ACT were established using a group of 64 children who were divided into two subgroups, with one subgroup comprising children without chronic kidney disease or coagulation disorder (age 1.2–17.5 years, median 9.7 years) and one consisting of 32 uremic patients (age 0.6–17.5 years, median 13.7 years). In a second group of 13 patients (aged 7–17 years), all of whom were undergoing high-flux dialysis (HD) with regional citrate anticoagulation (RCA), we assessed 73 post-filter blood samples for ionized calcium and ACT. A receiver operating characteristic graph was used to identify the iCa threshold needed to achieve adequate anticoagulation. Normal values for ACT were 90 s [2 standard deviations (SD) 72–109] in healthy children and 94 s (2 SD 75–113) in the uremic children. There was no statistically significant difference between the groups. In the children undergoing HD with RCA, the post-filter iCa level correlated with ACT ( r = −0.94, p < 0.001). A post-filter iCa level of ≤0.30 mmol/l reliably predicted an ACT >120 s. Our citrate protocol [citrate 3% rate (ml/h) ≈ blood flow rate (ml/min) × 2] meets the established criteria with a high sensitivity. Based on these results, we conclude that the post-filter iCa level can be reliably used for the management of extracorporeal anticoagulation with citrate in pediatric HD. We recommend the application of our citrate prescription protocol in the setting of pediatric intermittent hemodialysis. [ABSTRACT FROM AUTHOR]

Currently, about two-thirds of hemodialysis patients worldwide are treated with high-flux membranes. This is most likely based on the assumption that the extended solute clearance that can be obtained with more open membranes will contribute to improved clinical outcome. To have full advantage of convective solute removal, hemodiafiltration offers a superior modality as compared to both low-flux and high-flux hemodialysis. However, this technique is offered to only a minority of patients. In this review, we summarize the available clinical evidence on hemodiafiltration and define still remaining questions. [ABSTRACT FROM AUTHOR]

Growing evidence suggests the superiority of on-line hemodiafiltration (HDF) compared with the conventional hemodialysis technique in many aspects; however, on-line HDF is still not used worldwide, including in Southeast Asia. The purpose of this study is to compare various clinical outcomes between on-line HDF and high-flux hemodialysis (HFHD). This was a single-center three-year prospective observational study that demonstrated the clinical parameters after switching from HFHD to on-line HDF in 22 HDF patients, whose average age was 58.1 ± 13.3 years. The incidence of intradialytic undesired events, including hypotension, decreased and an apparent increase in appetite and an improvement in overall well-being were recorded by most patients after switching to on-line HDF. The data for dry weight, body mass index, and normalized protein nitrogen appearance, which represent nutritional status, showed a significant improvement while still maintaining a satisfactory albumin level. The adequacy in terms of urea reduction ratio significantly increased. The serum predialysis β2-microglobulin levels were reduced by 25.7% from 31.1 ± 3.1 to 23.1 ± 4.8 mg/L ( P < 0.05) at six months and remained constant during the three years of follow-up. The patients' lipid profile was well controlled, and the mean C-reactive protein value was still maintained in the normal range. In conclusion, our three-year experience showed that on-line HDF is a well-tolerated treatment with a lower incidence of intradialytic undesired events. The potential benefits may include the effective removal of higher molecular weight uremic toxins and an improved nutritional status, along with a low inflammatory state. [ABSTRACT FROM AUTHOR]

Infective spondylodiscitis (ISD) is a rare but potentially devastating condition in hemodialysis (HD) patients. Reports are limited especially in patients receiving high-flux HD and hemodiafiltration (HDF). In a retrospective analysis, 13 patients on our maintenance high-flux HD/HDF program were identified as having has infective spondylodiscitis over a 10-year period (1997–2006), an incidence of approximately 1 episode every 215 patient-years. The incidence was around 3 times higher in patients dialyzing with tunnelled central venous catheters (TCVC) than in those with arteriovenous fistulae. Affected patients were elderly (mean age 70 years) and had multiple comorbidities. Access problems, particularly TCVC infection, were common in the months preceding it's onset. Tunnelled central venous catheter removal during these episodes did not necessarily prevent it. Diagnosis was based on a history of back pain, raised C-reactive protein, positive blood cultures, and characteristic magnetic resonance findings. Many patients were apyrexial and had normal white cell counts. In our patients on high-flux HD/hemodiafiltration, its incidence appears comparable to that in conventional HD settings. No patients had infection with waterborne organisms. Blood cultures were positive in 77%. Gram-positive organisms predominated, particularly Staphylococcus aureus. The major route of infection was hematogenous, with the most likely source the venous access. All received antibiotics for 6 to 12 weeks or until death. Only 2 patients underwent surgical drainage. Mortality was high (46%) and predicted by the development of complications, and by pre-existing cardiovascular comorbidity. Prevention, using strategies to reduce the prevalence of bacteremia, including limiting the use of TCVC, should be an overriding aim. [ABSTRACT FROM AUTHOR]

Convective treatments (high-flux hemodialysis (HD), hemodiafiltration and hemofiltration) are characterized by enhanced removal of middle and large molecular weight solutes compared with conventional low-flux HD. As these molecules are claimed to play an important role in the genesis of many complications of chronic HD, the availability of these techniques represented an intriguing innovation and a possible means to improve the still poor prognosis of HD patients. Here we will critically review the most important published studies comparing convective treatments with low-flux HD on chronic morbidity, preservation of residual renal function, and long-term survival. [ABSTRACT FROM AUTHOR]

Significant technological changes in blood flow rate, dialyzer membrane permeability, bicarbonate dialysate, and ultrafiltration-controlled delivery systems permitted the implementation of 3 modifications to conventional hemodialysis as follows: high-efficiency hemodialysis (HEHD), high-flux hemodialysis (HFHD), and double-high-flux hemodiafiltration (HDF). The impact of these techniques on the quantity of the treatment administered and treatment time were assessed. One hundred and eighty-three patients were enrolled over 6 years. Monthly Kt/Vurea and dialysis treatment time were compared among the treatment techniques. In vivo extracorporeal clearances were measured for the dialyzers used. In vivo kinetically derived effective dialyzer clearances were calculated from Kt/V. Patient survival and standardized mortality ratio (SMR) were determined for each treatment modality. Treatment time averaged 192±28, 176±29, and 159±32 min, Kt/Vurea averaged 1.33±.34, 1.29±.30, 1.41±.32, and in vivo delivered urea clearance averaged 222±51, 272±34, and 333±43 mL/min for HEHD, HFHD, and HDF, respectively. These results were achieved even in patients with body weights in excess of 80 kgs. Net ultrafiltration rate during the treatment reached 20–30 mL/min, without clinical untoward effects. Blood flow rate ranged between 450–650 mL/min in all patients. Kaplan-Meier Survival analysis yielded a significant difference when high-efficiency treatments were compared with USRDS outcomes. Standardized mortality ratio analysis showed significance for only HDF vs. USRDS. High-efficiency treatments can provide the same quantity of treatment in a shorter period of time without affecting mortality. The increased spectrum of solutes removal provided by HFHD and HDF may be a further advantage of these treatments. [ABSTRACT FROM AUTHOR]

Effects of high-flux hemodialysis on oxidant stress. Background. Neutrophil oxygen radical production is increased in end-stage renal disease (ESRD) patients and it is further enhanced during dialysis with low-flux cellulosic membranes. This increased oxygen radical production may contribute to the protein and lipid oxidation observed in ESRD patients. We tested the hypothesis that high-flux hemodialysis does not increase oxygen radical production and that it is not associated with protein oxidation. Methods. Neutrophil oxygen radical production was measured during dialysis with high-flux dialyzers containing polysulfone and cellulose triacetate membranes. Free sulfhydryl and carbonyl groups and advanced oxidation protein products were measured to assess plasma protein oxidation. Results. Pre-dialysis, neutrophil oxygen radical production was significantly greater than normal and increased significantly as blood passed through the dialyzer in the first 30 minutes of dialysis. Post-dialysis, however, neutrophil oxygen radical production had decreased and was not different from normal. Pre-dialysis, significant plasma protein oxidation was evident from reduced free sulfhydryl groups, increased carbonyl groups, and increased advanced oxidation protein products. Post-dialysis, plasma protein free sulfhydryl groups had increased to normal levels, while plasma protein carbonyl groups increased slightly, and advanced oxidation protein products remained unchanged. Conclusions. The results of this study show that neutrophil oxygen radical production normalizes during high-flux dialysis, despite a transient increase early in dialysis. This decrease in oxygen radical production is associated with an improvement in some, but not all, measures of protein oxidation. [ABSTRACT FROM AUTHOR]

The importance of convective transport. Background. Despite technological advances in dialysis equipment and modalities, survival, morbidity, and quality of life of hemodialysis patients are still severely affected by acute intradialytic and long-term complications, possibly related to the treatment itself. Convective treatments, such as high-flux hemodialysis, hemodiafiltration, and hemofiltration are increasingly suggested as further improvements over standard diffusive hemodialysis. The membranes used for these techniques are high-flux semisynthetic and synthetic membranes. Characteristics of these membranes are high permeability, which allows convective removal of water and electrolytes and higher clearance of middle and large molecular weight solutes, and high biocompatibility, which minimizes the “inflammatory response” secondary to interactions between blood and the artificial material of the hemodialysis system. Methods. With the specific aim of verifying the superiority of convective treatments in reducing morbidity and mortality, we performed a review of the published literature. Results. Some epidemiological studies suggest that convective treatments reduce morbidity and mortality among dialysis patients. However, the results of the published prospective randomized controlled trials are conflicting. Moreover, since convective treatments are usually performed with synthetic biocompatible membranes, it is hard to separate the effect of convection from the effect of biocompatibility. Conclusions. To finally assess the effect of high-flux membranes on morbidity and mortality, the results of two randomized, controlled clinical trials (HEMO study and MPO study) specifically designed with this aim are needed. [ABSTRACT FROM AUTHOR]

Renal anemia significantly affects the morbidity and mortality of dialysis patients. The aim of the present study was to establish whether the severity of anemia and success of its treatment differs when using high-flux (HF) or low-flux (LF) hemodialysis. Twenty-five patients on long-term hemodialysis with a mean hematocrit (Hct) of 33%, Salb of 36 g/L, and Kt/Vurea of 1.5 were divided into Groups X (n = 13) and Y (n = 12) in a prospective randomized crossover study. Group X was initially treated with LF hemodialysis to be followed by HF hemodialysis for 8 weeks each time. Group Y started with 8 week HF hemodialysis and continued, after crossover, with 8 weeks of LF hemodialysis. HF and LF hemodialysis were performed with polysulfone dialyzers F 7HPS and F60S (Fresenius Medical Care, Bad Homburg, Germany). Hct values, examined at 2 week intervals, did not differ significantly between Groups X and Y during 16 weeks of the study at any measuring interval. In another analysis, all results of HF hemodialysis (first 8 weeks of Y + second 8 weeks of X) were pooled as were all data of LF hemodialysis (first 8 weeks of X + second 8 weeks of Y). No significant relationships were noted between duration of treatment with HF hemodialysis and Hct (n = 72, rS = 0.11, p = 0.36) and between duration of LF hemodialysis and Hct (n = 74, rS = 0.02, p = 0.87) in the newly formed groups. The Hct measured during HF hemodialysis and LF hemodialysis did not differ significantly. Analysis of variance did not reveal a relationship between Hct and the HF or LF membrane. As HF and LF hemodialysis differed significantly in Kt/Vurea , the variables were adjusted to identical Kt/Vurea using analysis of covariance. No relationship between Hct and dialysis membrane permeability was demonstrated even in this case. Use of biocompatible LF and HF membranes in standard hemodialysis modes under conditions of adequate dose of dialysis... [ABSTRACT FROM AUTHOR]

Background/AIMS: In spite of the better efficiency of on-line hemodiafiltration (HDF) compared with conventional hemodialysis (HD), it is relatively expensive. The aim of this study was to assess the advantages in the biochemical, hemodynamic and clinical effects in uremic patients treated with on-line HDF and with different frequencies of combination high-flux HD. METHODS: One hundred eleven patients were divided into four groups receiving different frequencies of on-line HDF (thrice, twice, once per week) and high-flux HD. RESULTS: Hemodynamic parameters including maximum drop of systolic blood pressure, episodes of symptomatic hypotension and mean saline infusion volumes during dialysis were reduced when frequencies of on-line HDF were increased. Significant improvements in urea kinetic were observed when frequencies of on-line HDF were increased. On-line HDF significantly reduced the amount of erythropoietin needed and improved intra- and inter-dialysis symptoms, physical well-being, menstruation and skin pigmentation when frequency of HDF is increased to three time per week. CONCLUSION: On-line HDF offers a better cardiovascular stability and clinical improvement. Thrice weekly on-line HDF offers a significant benefit when compared with lower frequencies of HDF per week and high-flux HD. [ABSTRACT FROM AUTHOR]

Objective To investigate the changes in levels of serum soluble transferrin receptor (sTfR) after switching from maintenance hemodialysis to high-flux hemodialysis (HFD) in patients with uremia, and to analyze its related factors. Methods Forty patients undergoing low-flux maintenance hemodialysis were treated by high-flux maintenance hemodialysis for 12 months. The levels of sTfR, iron metabolism indices, anemia index and inflammatory index were measured before HFD treatment (T0) and after HFD treatment for 2 months (T1), 6 months (T2) and 12 months (T3). Pear-son correlation and multiple regression method were used to analyze the relationship between serum sTfR and other indexes. At the same time, we observed the changing trend of erythropoietin and the amount of iron therapy. Results Serum sTfR level was significantly decreased at T1 , T2 and T3 as compared with that at T0 , and significant difference was found (all P<0.01). Pearson correlation analysis showed that sTfR was positively correlated with Ret%, SF (r=0.154, 0.152;all P<0.05) and was negatively correlated with Hb, HCT, β2-MG and TBC (r =-0.251, -0.299, -0.384 and-0.166;P<0.01 or P<0.05). Multiple regression showed that HCT, TSAT andβ2-MG levels were closed related with serum sTfR level in HFD patients (all P<0.01). The erythropoietin and iron dosage in this group reduced with prolonged HFD treatment. Conclusions HFD can effectively improve renal anemia in patients with maintenance hemodialysis. The detection of sTfR level reflects the effects of iron reserves and erythropoietic stimulation on patients. [ABSTRACT FROM AUTHOR]

Objective To observe and explore the effects of high-flux hemodialysis (HFHD) on calcium and phosphorus metabolism in patients with maintenance hemodialysis (MHD) . Methods Eighty-six patients with MHD in our hospital from August 2012 to February 2014 were selected and randomly divided into the observation group and the control group. 43 cases in the observation group were treated with HFHD, while 43 patients in the control group were treated with low-flux hemodialysis (LFHD). All patients accepted hemodialysis for 6 months. Calcium, phosphorus, parathyroid hormone ( iPTH) and calcium-phosphorus product were measured and compared in the two groups before and after hemodialysis. Results The differences of calcium, phosphorus, iPTH and calcium-phosphorus product between two groups before treatment were not statistically significant (P > 0.05) . After hemodialysis, calcium, phosphorus, iPTH and calcium-phosphorus product were (3.2 ± 0.3) mmol/L, (1.8 ± 0.2) mmol/L, (156.5 ± 32.8) pg/mL and (32.5 ± 3.6) mg2/dL2 in the observation group, and were (2.1 ± 0.4) mmol/L, (2.1 ±0.2) mmol/L, (387.2 ± 74.5) pg/mL and (47.1 ± 4.3) mg²/dL² in the control group, respectively. The differences were statistically significant between the two groups (P < 0.05) . Conclusion HFHD can significantly eliminate phosphorus and iPTH, as well as improve serum calcium level in patients with MHD, thereby improving patient's calcium and phosphorus metabolism. [ABSTRACT FROM AUTHOR]

A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management. [ABSTRACT FROM AUTHOR]