Journal Mobile Options
Table of Contents
Vol. 22, No. 6, 2004
Issue release date: 2004
Blood Purif 2004;22:481–489

Daily Hemofiltration for End-Stage Renal Disease: A Feasibility and Efficacy Trial

Jaber B.L. · Zimmerman D.L. · Teehan G.S. · Swedko P. · Burns K. · Meyer J.B. · Leypoldt J.K.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Although conventional hemodialysis (CHD) is currently provided primarily on an intermittent basis for patients with end-stage renal diseases (ESRD), the value of daily dialysis is well documented. Daily hemofiltration (DHF) is a convective therapy that has received little attention as an alternative to CHD. The aim of this feasibility study was to validate and assess the efficacy of DHF (6 times/week) as an alternative to CHD (3 times/week) in patients with ESRD. Methods: In this prospective single-arm open-labeled study, DHF was administered over 4 weeks after a 1-week run-in phase period of CHD. Blood samples were drawn at baseline and on a weekly basis during the trial, and ultrafiltrate samples were collected weekly during the DHF period. The primary endpoint was to achieve a daily spKt/V of 0.40 (equivalent to a weekly stdKt/V of ∼2.0). To achieve this goal, the DHF prescription consisted of an exchange volume of 40% of total body water. Secondary endpoints were the evaluation of blood pressure and anemia parameters, nutritional and mineral metabolism markers and health-related quality of life measures. Results: Twelve patients completed the study. Mean age was 54 years, two-thirds were men, and 83% had arteriovenous fistulae. DHF delivered a mean (±SD) spKt/V of 0.44 ± 0.06. This goal was reached by delivering an exchange volume of 13–14 liters, consisting of a replacement fluid volume of 11.7 ± 1.9 l/session and net fluid loss of 1.4 ± 0.1 l/session. Conversion from CHD to DHF resulted in marked reduction in treatment time (3.8 vs. 2 h/session, p < 0.001) and net fluid loss (2.6 vs. 1.4 l/session, p < 0.001). Calculated weekly standard Kt/V during the last week of DHF was 1.9 ± 0.2. DHF achieved a median β2-microglobulin (β2-M) removal of 170 mg/session, resulting in a decrease of mid-week pre-therapy β2-M levels (48 ± 34 vs. 36 ± 25 mg/l, p = 0.07). Compared with CHD, DHF resulted in lower systolic (143 ± 19 vs. 133 ± 16 mm Hg, p = 0.002) and diastolic (79 ± 11 vs. 72 ± 12 mm Hg, p = 0.002) blood pressure, reduction in antihypertensive medications (2.1 ± 0.7 vs. 1.1 ± 0.8, p = 0.002), higher caloric intake (1,778 ± 441 vs. 2,044 ± 564 kcal/day, p = 0.01), higher normalized protein catabolic rate (0.88 ± 0.17 vs. 1.00 ± 0.35 g/kg/day, p = 0.05), higher pre-albumin levels (330 ± 50 vs. 378 ± 84 g/dl, p = 0.06), higher vitality (p = 0.02), improved cognitive function (p = 0.04) and less symptoms/problems (p = 0.03). Serum albumin and potassium levels remained unchanged but the serum bicarbonate level dropped during the 1-month period of DHF. Conclusions: DHF (6 times/week) over a 1-month period achieved a weekly stdKt/V of ∼2.0, which is similar to that recommended for 3 times weekly CHD, reduced β2-M levels, lowered blood pressure, and had some beneficial effect on nutritional parameters, and health-related quality of life measures.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. National Kidney Foundation: K/DOQI clinical practice guidelines for hemodialysis adequacy. Am J Kidney Dis 2001;37:S1–S64.
  2. Buoncristiani U: Fifteen years of clinical experience with daily haemodialysis. Nephrol Dial Transplant 1998;13:148–151.
  3. Twardowski ZJ: Daily dialysis: Is this a reasonable option for the new millennium? Nephrol Dial Transplant 2001;16:1321–1324.
  4. Pierratos A: Daily hemodialysis: An update. Curr Opin Nephrol Hypertens 2002;11:165–171.
  5. Lockridge RS Jr, Spencer M, Craft V, Pipkin M, Campbell D, McPhatter L, Albert J, Anderson H, Jennings F, Barger T: Nocturnal home hemodialysis in North America. Adv Ren Replace Ther 2001;8:250–256.
  6. Mohr PE, Neumann PJ, Franco SJ, Marainen J, Lockridge R, Ting G: The quality of life and economic implications of daily dialysis. Policy Anal Brief H Ser 1999;1:1–4.
  7. Ting GO: The case for short daily hemodialysis, why sDHD will be the predominant modality for frequent dialysis. ASAIO J 2001;47:443–445.
  8. Lindsay RM, Heidenheim AP, Leitch R, Ryan H, Kroeker A, Peters K, Workentin L, Nesrallah G, Prakash S, Kortas C: Short daily versus long nocturnal hemodialysis. Daily/Nocturnal Dialysis Study Group. ASAIO J 2001;47:449–455.
  9. Henderson LW, Livoti LG, Ford CA, Kelly AB, Lysaght MJ: Clinical experience with intermittent hemodiafiltrations. Trans Am Soc Artif Intern Organs 1973;19:119–123.
  10. Macias WL, Mueller BA, Scarim SK, Robinson M, Rudy DW: Continuous venovenous hemofiltration: An alternative to continuous arteriovenous hemofiltration and hemodiafiltration in acute renal failure. Am J Kidney Dis 1991;18:451–458.
  11. De Vries PM, Olthof CG, Solf A, Schuenemann B, Oe PL, Quellhorst E, Schneider H, Donker AJ: Fluid balance during haemodialysis and haemofiltration: The effect of dialysate sodium and a variable ultrafiltration rate. Nephrol Dial Transplant 1991;6:257–263.
  12. Quellhorst E, Hildebrand U, Solf A: Long-term morbidity: Hemofiltration vs. hemodialysis. Contrib Nephrol. Basel, Karger, 1995, vol 113, pp 110–119.
  13. Altieri P, Sorba G, Bolasco P, Asproni E, Ledebo I, Bostrom M, Ferrara R, Ganadu M, Cossu M, Cadinu F, Cabiddu G, Serra G, Casu D, Bolasco F, Passaghe M, Ghisu T, Sau G, Ginanni A, Pistis R, Calvisi L, Galfre A: Pre-dilution haemofiltration – The Sardinian multicentre studies: Present and future. The Sardinian Collaborative Study Group on Haemofiltration On-Line. Nephrol Dial Transplant 2000;15:55–59.
  14. McCarthy JT, Moran J, Posen G, Leypoldt JK, Hull AR, Jaber BL, Correa-Rotter R: A time for rediscovery: Chronic hemofiltration for end-stage renal disease. Semin Dial 2003;16:199–207.
  15. Watson PE, Watson ID, Batt RD: Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr 1980;33:27–39.
  16. Meyer KB, Espindle DM, DeGiacomo JM, Jenuelson CS, Kurtin PS, Davies AR: Monitoring dialysis patients’ health status. Am J Kidney Dis 1994;24:267–279.
  17. Hays R, Kallich J, DL M, Coons S, Carter W: Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res 1994;3:329–338.
  18. Daugirdas JT: Second-generation logarithmic estimates of single-pool variable volume: An analysis of error. J Am Soc Nephrol 1993;4:1205–1213.
  19. Daugirdas J, Schneditz D: Overestimation of hemodialysis dose depends on dialysis efficiency by regional blood flow but not by conventional two-pool urea kinetic analysis. ASAIO J 1995;41:M719–M724.
  20. Bankhead MM, Toto RD, Star RA: Accuracy of urea removal estimated by kinetic models. Kidney Int 1995;48:785–793.
  21. Gotch FA: The current place of urea kinetic modelling with respect to different dialysis modalities. Nephrol Dial Transplant 1998;13:10–14.
  22. Depner TA: Prescribing Hemodialysis: A Guide to Urea Modeling. Boston, Kluwer Academic, 1991.
  23. Zimmerman DL, Swedko P, Posen G, Burns K: Daily hemofiltration with a simplified method of delivery (abstract). J Am Soc Nephrol 2002;13:61A.

    External Resources

  24. Teehan GS, Pingree P, Morena M, Meyer K, Lambert L, Jaber BL: Effect of daily hemofiltration on anemia and blood pressure management in ESRD patients (abstract). J Am Soc Nephrol 2002;13:411A.

    External Resources

  25. Jaber BL, Zimmerman DL, Leypoldt JK: Adequacy of daily hemofiltration: clinical evaluation of standard Kt/V (abstract). Hemodialysis Int 2003;7:80.

    External Resources

  26. Zimmerman DL, Swedko PJ, Posen GA, Burns KD: Daily hemofiltration with a simplified method of delivery. ASAIO J 2003;49:426–429.
  27. Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019.
  28. Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, Mujais S: Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002;13:1307–1320.
  29. Leypoldt JK, Jaber BL, Lysaght MJ, McCarthy JT, Moran J: Kinetics and dosing predictions for daily haemofiltration. Nephrol Dial Transplant 2003;18:769–776.
  30. Pierides AM, Schniepp B, Johnson WJ: Hemofiltration in the treatment of acute and chronic renal failure. Proc Clin Dial Transplant Forum 1979;9:50–53.
  31. Gotch FA: Modeling the dose of home dialysis. Home Hemodial Int 1999;3:37–40.
  32. Canaud B, Assounga A, Kerr P, Aznar R, Mion C: Failure of a daily haemofiltration programme using a highly permeable membrane to return β2-microglobulin concentrations to normal in haemodialysis patients. Nephrol Dial Transplant 1992;7:924–930.
  33. Raj DS, Ouwendyk M, Francœur R, Pierratos A: β2-Microglobulin kinetics in nocturnal haemodialysis. Nephrol Dial Transplant 2000;15:58–64.
  34. Maduell F, Navarro V, Torregrosa E, Rius A, Dicenta F, Cruz MC, Ferrero JA: Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration. Kidney Int 2003;64:305–313.
  35. Ingenbleek Y, De Visscher M, De Nayer P: Measurement of prealbumin as index of protein-calorie malnutrition. Lancet 1972;ii:106–109.
  36. Zeman F: Clinical Nutrition and Dietetics, ed 2. New York, Macmillan, 1993.
  37. Mucsi I, Hercz G, Uldall R, Ouwendyk M, Francœur R, Pierratos A: Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis. Kidney Int 1998;53:1399–1404.
  38. Gotch FA, Panlilio F, Sergeyeva O, Rosales L, Folden T, Kaysen G, Levin NW: A kinetic model of inorganic phosphorus mass balance in hemodialysis therapy. Blood Purif 2003;21:51–57.
  39. Canaud B, Bosc J, Leray H, Morena M, Stec F: Microbiologic purity of dialysate: Rationale and technical aspects. Blood Purif 2000;18:200–213.
  40. Eisenbach G, Shaldon S: Substitution fluid for hemofiltration; in Henderson L, Quellhorst E, Baldamus C, Lysaght M (eds): Hemofiltration. Berlin, Springer, 1986, pp 101–110.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50