Consequences of increasing convection onto patient care and protein removal in hemodialysis - Fig 2

<p>Panel <b>A) Example of TMP variations during dialysis</b>, for one patient with the four different convection volumes prescribed as to the protocol. TMP remained stable in haemodialysis and in low convection HDF while it increased during the treatment with optimal and maximum convection HDF. In the latter the increase was steeper and resulted in the appearance of TMP alarms that motivated nursing staff interventions. Panel B) depicts the <b>TMP over convection volume function</b>: each point represents the average of ~400 measurements during every dialysis of the 141 dialysis studied using a XEVONTA 1.8 m², totaling >56,000 TMP measurements. Panel C) plots the <b>number of alarms</b> recorded during the assessed treatments and shows that it was around x10 fold in maximum when compared to optimal convection treatments. Panel D) plots the <b>number of reductions in infusion flow</b> necessary to avoid the alarms and pursue the treatment for the 4 treatment types, showing that infusion reduction was almost constantly required in maximum convection HDF at least in one occasion (a mean of 1 per session).</p

Dialysis feasibility: Alarms, nursing staff interventions and convection modifications.

<p>Dialysis feasibility: Alarms, nursing staff interventions and convection modifications.</p

Convection flows and volumes as well as TMP values by dialysis condition.

<p>Convection flows and volumes as well as TMP values by dialysis condition.</p

Dialysis efficacy.

<p>Dialysis efficacy.</p

Electron microscopy of the membrane AMEMBRIS used in the study.

<p>An example of one dialyser used in hemodialysis is given in the upper panels (A, B and C; x2,000 magnification) and of one dialyser used in hemodiafiltration in the lower panels (D, E and F; x40,000 magnification). (A) The external wall displays visible pores, significantly larger than the pores of the internal wall (B and C), which are not visible at x2,000 magnification. (B) The arrow points at one erythrocyte located between 2 cumulated material and crystals from the rinsing fluid (saline and sodium dodecyl sulphate). (C) Sparse crystals are laying on the internal wall. Three different zones of the internal wall of the dialyser are displayed in the lower panels at x40,000 magnification, one with practically all the pores visible and accessible (D), one with some pores covered by a proteinaceous material (E) and one where all the pores are covered by a uniform material attached to the membrane (F).</p

Patients characteristics.

<p>Patients characteristics.</p

Removal of five different protein compounds in mg/session, analysed following the convection volumes obtained in the different dialysis conditions.

<p>It is observed that the variation in β-2m removal was not significantly different with HDF (slight linear increase with increasing convection volume), while the increase in removal was more evident in the higher mol wt range, being clearly exponential for albumin; albumin loss was around double when increasing from optimal convection to maximum convection HDF.</p

Schematic of the study protocol.

<p>The abbreviations are as follows: HD, hemodialysis; OL—HDF, On-line hemodiafiltration; Q_UF, ultrafiltration flow.</p