@article{MostovayaGrootemanBasileetal.2015, author = {Mostovaya, Ira M. and Grooteman, Muriel P.C. and Basile, Carlo and Davenport, Andrew and de Roij van Zuijdewijn, Camiel L.M. and Wanner, Christoph and Nub{\´e}, Menso J. and Blankestijn, Peter J.}, title = {High convection volume in online post-dilution haemodiafiltration: relevance, safety and costs}, series = {Clinical Kidney Journal}, volume = {8}, journal = {Clinical Kidney Journal}, number = {4}, doi = {10.1093/ckj/sfv040}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-149814}, pages = {368-373}, year = {2015}, abstract = {Increasing evidence suggests that treatment with online post-dilution haemodiafiltration (HDF) improves clinical outcome in patients with end-stage kidney disease, if compared with haemodialysis (HD). Although the primary analyses of three large randomized controlled trials (RCTs) showed inconclusive results, post hoc analyses of these and previous observational studies comparing online post-dilution HDF with HD showed that the risk of overall and cardiovascular mortality is lowest in patients who are treated with high-volume HDF. As such, the magnitude of the convection volume seems crucial and can be considered as the 'dose' of HDF. In this narrative review, the relevance of high convection volume in online post-dilution HDF is discussed. In addition, we briefly touch upon some safety and cost issues.}, language = {en} } @article{KrieterKerwagenRuethetal.2019, author = {Krieter, Detlef H. and Kerwagen, Simon and R{\"u}th, Marieke and Lemke, Horst-Dieter and Wanner, Christoph}, title = {Differences in dialysis efficacy have limited effects on protein-bound uremic toxins plasma levels over time}, series = {Toxins}, volume = {11}, journal = {Toxins}, number = {4}, doi = {10.3390/toxins11010047}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201770}, pages = {47}, year = {2019}, abstract = {The protein-bound uremic toxins para-cresyl sulfate (pCS) and indoxyl sulfate (IS) are associated with cardiovascular disease in chronic renal failure, but the effect of different dialysis procedures on their plasma levels over time is poorly studied. The present prospective, randomized, cross-over trial tested dialysis efficacy and monitored pre-treatment pCS and IS concentrations in 15 patients on low-flux and high-flux hemodialysis and high-convective volume postdilution hemodiafiltration over six weeks each. Although hemodiafiltration achieved by far the highest toxin removal, only the mean total IS level was decreased at week three (16.6 ± 12.1 mg/L) compared to baseline (18.9 ± 13.0 mg/L, p = 0.027) and to low-flux dialysis (20.0 ± 12.7 mg/L, p = 0.021). At week six, the total IS concentration in hemodiafiltration reached the initial values again. Concentrations of free IS and free and total pCS remained unaltered. Highest beta2-microglobulin elimination in hemodiafiltration (p < 0.001) led to a persistent decrease of the plasma levels at week three and six (each p < 0.001). In contrast, absent removal in low-flux dialysis resulted in rising beta2-microglobulin concentrations (p < 0.001). In conclusion, this trial demonstrated that even large differences in instantaneous protein-bound toxin removal by current extracorporeal dialysis techniques may have only limited impact on IS and pCS plasma levels in the longer term.}, language = {en} }