Hemodialysis vs. Hemodiafiltration....the future..or another fad ?

[billmoria]

HDF is not for everyone and it is my personal belief that clinics should have more than one type of machine. What works for one person does not work for another. My bleeding time when the needles were pulled out used to be about 15 minutes. On HDF it is 8 minutes or less and I think it could be shorter but I don't see a reason to try and see if I could do 3 minutes instead of 4. I don't know why just reporting my experience.
I am not sure of the technical term but on HD my % averaged at around 82% and on HDF it averages at 92%.
My after dialysis (i.e.) the next day experience is a bit of pot luck. I have had some days when I have felt tired and washed out which is not good. However, I have days when I feel a lot better and am able to accomplish more.

[KICKSTART]

All our machines are the 5008's billmoira, but they can be changed to do HD , they just automatically do HDF !  Im in the UK  too !

[greg10]

What ever happened to Dr. Evil, the original poster who was a solo nephrologist somewhere in the US? 
He gave a good primer considering it was from 2006, but some of the statements are probably inaccurate, such as HDF removing mid to high molecular weight proteins.

[Zach]

He gave a good primer considering it was from 2006, but some of the statements are probably inaccurate, such as HDF removing mid to high molecular weight proteins.

Why do you think that those statements are incorrect?

[greg10]

Oh, this newbie was just guessing it is hard to pass too many camels through the eye of a needle no matter how hard your squeeze.

The method and amount of ultrafiltration that is asked of HDF makes it too easy to have high trans-membrane pressure and filter clotting.  This is not just 1 to 3 liters of ultrafiltration of HD  but rather 15 to 20 liters of HDF and it is occurring across a largely diluted blood solution.  No such dilution occurs with normal HD.

It is well known that extremely high filtration pressures, besides creating a risk of capillary damage and rupture, also cause significant deterioration of the membrane due to the progressive depositing and thickening of the protein layer on its surface leading to a loss of hydraulic and solute permeability. In addition, in the second part of the dialyser, the efficiency of solute removal is likely to be significantly compromised by the massive dilution of blood, reducing the solute concentration available for diffusion and convection across the membrane, and by the co-current blood-dialysate flows, further reducing the gradient for solute diffusion into the dialysate flow.

http://ndt.oxfordjournals.org/content/22/6/1672.full#T1