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The ultracontrol system in the Gambro machines or the Fresenius CorDiax automated replacement system are technological advances that attempt to maximise the convective volume administered automatically.
We included 63 patients, 44 males and 19 females, with a mean age of In the first stage, each patient was assessed over three sessions with a monitor before the change of software was implemented. During the second stage of the study, with the new version of the monitor, we used the automated infusion system, in which it was not necessary to introduce any value. We considered the demographic characteristics of each patient: age, sex, time on dialysis, body surface area and body mass index.
The dialysis parameters recorded in each session were: time scheduled, real time, dialyser, type of vascular access, blood flow, dialysate flow Qd , heparin dose, Kt measured automatically by ionic dialysance, recirculation rate, arterial blood pressure, venous blood pressure, transmembrane pressure, initial and final haemoglobin, ultrafiltration, minimum plasma volume, processed blood volume and total convective volume.
In the laboratory, we determined haemoglobin, haematocrit and albumin at each stage. Statistical analysis Statistical analysis was carried out using the SPSS statistical software version The dialysers used were: 1. Each patient had the same dialyser in both study periods. The anticoagulation used was heparin sodium in 6.
The dialysis time prescribed was There were no statistically significant differences in the laboratory parameters, the real dialysis time, the Qb or other dialysis parameters Table 1. The only exception was the ultrafiltration volume: 2. Arterial pressure, venous pressure and transmembrane pressure were similar in both study periods, as well as the recirculation rate, the processed blood volume and the dialysis dose measured by ionic dialysance and expressed as Kt Table 1.
The replacement volume was significantly higher with the CorDiax monitor: These differences are maintained when we separate the sessions into the three days of the week Figure 1.
Table 2 also displays the absolute total convective volume, as well as volume related to dry weight, body surface area and body mass index and lastly the effective convective volume percentage of the total processed blood, with the differences being significant in all cases.
Patients with a catheter received a replacement volume below that of those with fistulas; however, upon changing to the CorDiax monitor, there was a significant increase in the replacement volume in patients with fistulas and those with tunnelled venous catheters Figure 2. The replacement volume increase was maintained regardless of the dialyser used, OL-HDF is a safe technique that improves intradialysis haemodynamic tolerance These data lead us to predict a progressive increase in this technique, and it will probably become the standard treatment in the near future.
However, there are still issues to be resolved with regard to HDF techniques. The first is a conceptual redesign.
A second issue to discuss is what the adequate convective volume should be per session. In a post-hoc analysis that assessed mortality in relation to the convective volume received, in the three randomised clinical trials, there was superiority in receiving a high convective volume.
In the Turkish study, when we analysed the patients by the median reinfusion volume, Logically, since it was a secondary analysis, there was a selection bias, since the patients who achieved a higher convective volume could be younger, with better vascular access and lower comorbidity11, The main limiting factors in achieving high convective volumes were Qb, time and haemoconcentration in the dialyser.
In recent years, there has been technological development with the aim of achieving an increase in convective volume.
New dialysers were developed with an increased pore size and some were developed with an increase in the diameter of the capillary fibres specifically designed to increase the convective volume. The other advancement corresponded to the development of new dialysis monitors that allow an automated Qi in order to maximise the convective volume.
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