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Daniela Germin Petrović

Bio: Daniela Germin Petrović is an academic researcher. The author has contributed to research in topics: Dialysis adequacy & Dialysis. The author has an hindex of 1, co-authored 1 publications receiving 1 citations.

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TL;DR: Results show that AFB reduces intradialytic symptoms and improves patient quality of life, and provided better control of dry body weight and post-dialysis systolic and diastolic blood pressure than did HD.
Abstract: Background Acetate-free biofiltration (AFB) is a diffusive-convective dialysis procedure that utilizes a high-flux membrane (AN69), postdilution infusion of sodium bicarbonate solution, and a dialysate that is completely free of any buffer. The AFB technique may provide better cardiovascular stability and reduce intradialytic side effects. The aim of the present study was to investigate the influence of AFB, compared with bicarbonate dialysis (HD), on intradialytic cardiovascular stability and dialysis-induced morbidity. Patients and Methods The study included 5 patients with end-stage renal disease. Their mean age was 57.2 ± 1.6 years, and they had been undergoing hemodialysis (HD) for an average of 25 ± 22 months. The patients were followed for 1 year: they were treated first with HD for 6 months, followed by 6 months on AFB, maintaining all the dialytic parameters used during the HD. While the patients were on HD and AFB, we evaluated the number of episodes of intradialytic hypotension (IDH); the episodes of muscle cramps, nausea, headache (dialysis intolerance); dry body weight; and intradialysis weight loss. Data on dialysis adequacy and serum biochemistry were obtained monthly, and albumin and cholesterol were determined every 3 months. Results The results showed that after the switch from HD to AFB, there was a significant reduction in IDH (36.8% on HD, 13.5% on AFB; p<0.005) and in symptoms of dialysis intolerance (15.8% on HD, 2.8% on AFB; p<0.005). Intradialysis weight loss increased significantly on AFB (3.47 kg on HD, 3.63 kg on AFB; p<0.005), whereas dry body weight remained stable. Post-dialysis systolic blood pressure increased significantly on AFB (132.6 ± 7.7 mmHg on HD, 140.6 ± 5.4 mmHg on AFB; p<0.005). Post-dialysis diastolic blood pressure was also higher on AFB (76.9 ± 4.9 mmHg on HD, 81.8 ± 3.4 mmHg on AFB; p<0.005). The other parameters observed remained unchanged. Conclusion The percentage of dialysis sessions in which IDH and symptoms of dialysis intolerance occurred decreased significantly on AFB. AFB provided better control of dry body weight and post-dialysis systolic and diastolic blood pressure than did HD. These results show that AFB reduces intradialytic symptoms and improves patient quality of life.

1 citations


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TL;DR: A review of the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis is presented in this paper, where the authors summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population.
Abstract: Introduction The search for the "perfect" renal replacement therapy has been paralleled by the search for the perfect biomarkers for assessing dialysis adequacy. Three main families of markers have been assessed: small molecules (prototype: urea); middle molecules (prototype β2-microglobulin); comprehensive and nutritional markers (prototype of the simplified assessment, albumin levels; composite indexes as malnutrition-inflammation score). After an era of standardization of dialysis treatment, personalized dialysis schedules are increasingly proposed, challenging the dogma of thrice-weekly hemodialysis. Areas covered In this review, we describe the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis. Expert opinion In the era of personalized dialysis, the assessment of dialysis adequacy should be likewise personalized, due to the limits of "one size fits all" approaches. We have tried to summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population, which would probably benefit from tailor-made dialysis prescriptions. While no single biomarker allows precisely tailoring the dialysis dose, we suggest using a combination of clinical and biological markers to prescribe dialysis according to comorbidity, life expectancy, residual kidney function, and small and medium-size molecule depuration.

5 citations