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Kidney Week

Abstract: TH-PO359

Comparison of Removal Efficiency and Biocompatibility Between Pre- and Post-Dilution On-line Hemodiafiltration

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Sakurai, Kenji, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan
  • Saito, Takeshi, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan
  • Hosoya, Hiromi, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan
  • Kurihara, Yoshitaka, Hashimoto Clinic, Sagamihara, KANAGAWA, Japan
  • Ishii, Daisuke, Kitasato University Hospital, Sagamihara Kanagawa, Japan
  • Yoshida, Kazunari, Department of Urology Kitasato University School of Medicine, Sagamihara, Japan
  • Kokubo, Kenichi, Kitasato University School of Allied Health Sciences, Sagamihara, kanagawa, Japan
  • Hyodo, Toru, Eijin Clinic and Cambodian Association of Nephrology, Hiratsuka, KANAGAWA, Japan

In Japan in late-2016, 329,609 patients received dialysis, 24.2% of whom received hemodiafiltration (HDF). In 79% of HDF, the on-line mode is used, which is mostly performed with the pre-dilution mode (pre-HDF). However, in Europe, all HDF sessions use the post-dilution mode (post-HDF). We previously assessed differences in biocompatibility between pre- and post-HDF based on inflammatory markers and lymphocyte stimulation tests, and reported that pre-HDF is less physically stressful. Here, we used a more biocompatible hemodiafilter to study whether biocompatibility would differ between pre- and post-HDF, and assessed the solute removal efficiency of both modes.


Eight stable dialysis patients were included in this study. HDF was performed with Fineflux 210S eco (asymmetric triacetate membrane, NIPRO) at a blood flow rate of 250 mL/min and a total dialysate flow rate of 500 mL/min for 4 h/session. The substitution fluid volumes were 60 and 12 L/session for pre- and post-HDF, respectively. To test removal efficiency, urea, creatinine, b2-microglobulin (MG) (MW:11.8kDa) and a1-MG (MW:33kDa) levels were measured to determine the reduction rates. Albumin (Alb) leakage was also measured. To test biocompatibility, hs CRP, interleukin (IL)-6, tumor necrosis factor (TNF)-a, pentraxin (PTX)-3, intercellular adhesion molecule (ICAM)-1, and cluster of differentiation 62 platelet (CD62P; a platelet cell surface marker) levels were measured.


Post-HDF was more efficient at removing small-molecular-weight solutes than pre-HDF. The reduction rate of b2-MG was 81.2±2.6% for both modes. The reduction rates of a1-MG were 33.1±5.8% for pre-HDF and 37.4±3.9% for post-HDF, showing a significant difference (p<0.05). Alb leakages (g/session) were 2.8 for pre-HDF and 3.4 for post-HDF (p<0.05). No differences between the two modes were observed in the rates of changes in CRP, IL-6, TNF-a, ICAM-1, and PTX-3 levels. Increases in the expression rates of CD62P were 164.7±24.1% for pre-HDF and 210.7±44.2% for post-HDF (p<0.05).


The percent change in the CD62P expression rate was smaller for pre-HDF than for post-HDF; platelets may have been less activated during pre-HDF than during post-HDF under this study’s conditions. Post-HDF was more efficient at removing solutes.


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