On line haemodiafiltration: Effective removal of high molecular weight toxins and improvement in clinical manifestations of chronic haemodialysis patients

The aim of this study was to validate the purity of the injection fluid in an on-line haemodiafiltration (HDF) system, and to investigate whether the aggressive removal of high molecular weight toxins achieved by the on-line HDF will reduce symptoms such as shoulder pain and pruritus. The dialysate for substitution use contained no endotoxin, beta-D-glucan, or peptidoglycan, suggesting that contamination with gram-negative/positive bacteria and fungi are kept clear or at extremely low levels. No deleterious complications occurred during the on-line HDF treatments. The improvement in shoulder pain and pruritus indicated by a decrease in patients' self-rating scores, was more apparent with treatment that removed both beta 2-microglobulin (beta 2-m) and al-microglobulin (alpha 1-m) than with treatment removing either beta 2-m or alpha 1-m alone. On-line HDF is much easier to operate and less costly than conventional HDF, and it may become one of the standard therapies for chronic renal failure patients.