Principles and practice of internal Hemodiafiltration
Principles and practice of internal Hemodiafiltration
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DOI：
10.1159/000107248
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发表时间：
2007-01-01
期刊：
影响因子：
--
通讯作者：
Ronco, Claudio
中科院分区：
文献类型：
--
作者：
Fiore, Gianfranco Beniamino;Ronco, Claudio
最近有人提出，现代高通量膜的潜力可以利用所谓的内部血液滤过（iHDF）技术。原则上，iHDF的工作原理与高通量血液透析一样，但要求对流剂量与临床相关，可量化，并可能由操作人员调节。在本章中，我们简要概述了iHDF的理论、技术和实践方面，重点介绍了保证其对流势的机制，即内过滤/反过滤（IF/BF）现象。在理论基础上，强调了对流剂量在iHDF过程中的增强依赖于血液透析器在膜性能和流体动力学方面的明智设计，而对流的调节通过适当调节处理参数是可行的。中频/高炉测量似乎是可行的间接手段；然而，将技术从单纯的研究领域引入临床实践需要投资。如果开发的计算工具对临床医生来说足够方便，甚至可以在透析机本身中实现，则使用数学模型来量化IF/BF的另一种方法是。IF/BF“计算器”也代表了一种手段，使临床工作人员意识到在高通量血液透析器内发生的过滤现象。因此，在不久的将来，iHDF可能是一种辅助的、简化的技术，可以增加高通量对流治疗的临床扩散。版权所有(c) 2007 S. Karger AG，巴塞尔。
It has recently been suggested that the potentials of modern high-flux membranes could be exploited with the so-called internal hemodiafiltration (iHDF) technique. In principle, iHDF works just as high-flux hemodialysis but requires the convective dose to be clinically relevant, quantifiable and possibly adjustable by the operator. In this chapter, we briefly survey the theoretical, technological and practical aspects of iHDF, focusing on the mechanism ensuring its convective potential, i.e. the internal filtration/backfiltration (IF/BF) phenomenon. Based on theory, it is highlighted that the enhancement of the convective dose during iHDF relies upon a wise design of the hemodialyzer, both in terms of membrane performance and of hydrodynamics, whereas the adjustment of convection is feasible by proper regulation of the treatment parameters. IF/BF measurements appear to be feasible by indirect means; however, investments are needed to bring technology from the mere research field to the clinical practice. An alternative approach to IF/BF quantification is using mathematical models provided that the developed calculation tools are handy enough for the clinician, or even be implemented in the dialysis machine itself. IF/BF 'calculators' also represent a means to make the clinical staff conscious of the filtration phenomena that take place inside a high-flux hemodialyzer. It is concluded that iHDF is a possible complementary, simplified technique which could increase the clinical diffusion of high-flux convective treatments in the near future. Copyright (c) 2007 S. Karger AG, Basel.