Adequacy, benefits, complications, dose and efficacy of filtration - the minneapolis experience

Twenty-four patients were studied in an A-B-A format with 3 months of control hemodialysis, 12 months of hemofiltration, and 3 months return to control hemodialysis. Hemofiltration was performed in the postdilution mode using substitution fluid produced on-site, therapy being individually prescribed to match the creatinine removal on control hemodialysis. Stable serum chemistries and hematology were noted with hemofiltration, there being an improvement in the acid-base status of the patients. Less posttreatment fatigue, better blood pressure control, a lower incidence of hypotension, fever and cramps, and a reduced frequency and volume of fluid administration were achieved with hemofiltration. The incidence of nausea, vomiting, headaches, and pruritus was, however, higher with hemofiltration. A low incidence of pyrogen reactions (0.2%) with low associated morbidity was noted, demonstrating the safety of on-site production of substitution fluid for hemofiltration. Some of the improvements noted with hemofiltration persisted during the second control period of hemodialysis for reasons that are not clear.