A Two-Filter Adaptation to Achieve Hemodiafiltration with Enhanced Performance

IntroductionAdvancements in hemodialysis (HD) instrumentation have resulted in numerous breakthroughs in technology and significantly enhanced patient outcomes. Today, hemodiafiltration (HDF) which combines HD and hemofiltration has been widely used as an alternative to conventional HD in many countries. HDF is known to outperform conventional HD, offering more effective waste clearance and better fluid balance to patients. However, HDF requires newer-generation machines that are not accessible in many under-resourced geographical regions and societies. This study investigates a facile adaptation of conventional HD machines to achieve HDF. The objectives are to address the premature obsolescence of older but fully functional machines and to advocate for equal access to improved medical care and treatment. MethodsA bench-top experimental setup was established to evaluate the performance of HDF using a two-filter adaptation in comparison to that of standard HD. Urea clearance, human serum album loss, and hemolysis were assessed under identical operational conditions for both configurations. FindingsOur results show that the HDF configuration outperformed the HD configuration, with significantly higher urea clearance (268.31{+/-}44.17 mL/min via HDF vs. 53.33{+/-}13.20 mL/min via HD), but comparable human serum albumin loss and hemolysis levels. DiscussionThe explored two-filter adaptation presents a cost-effective method to achieve HDF with improved performance using conventional HD machines, with no added risk to patients. Further validation on patients in a hospital setting is necessary.