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. 2025 Jul 7:1-10.
doi: 10.1159/000546642. Online ahead of print.

Influence of Different Hemodialysis Biocontrols on the Achievement of the Convective Volume

Patricia Muñoz Ramos  1 , Laura Guasch  1 , David Conejo  1 , Esther Rodríguez  1 , Virginia López  1 , Borja Quiroga  2   3 , Mayra Ortega  1 , Rafael Lucena  1 , Marta Puerta  1 , Laura Medina  1 , Fabio Luca Procaccini  1 , Juan Martín-Navarro  1 , Roberto Alcázar  1   4 , Patricia de Sequera  1   3   4
Affiliations

Influence of Different Hemodialysis Biocontrols on the Achievement of the Convective Volume

Patricia Muñoz Ramos et al. Blood Purif. .

Abstract

Introduction: Post-dilution on-line hemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality in hemodialysis (HD) patients when high substitution volumes are achieved. To date, little emphasis has been placed on the impact of different biocontrols in achieving high replacement volumes. The aim of the present study was to compare the substitution volume achieved with three different monitors using the three available automatic systems.

Methods: Prospective, observational cross-over study of prevalent patients on post-dilution OL-HDF. Each patient underwent 9 consecutive post-dilution OL-HDF sessions with each of the monitors included in the study: Artis, 6008, and Surdial X with the corresponding biocontrols: UltraControl, AutoSub+, and Max-Sub, respectively. After each session, the final convective volume and other parameters related to HD and medium-molecule clearance were collected.

Results: Thirteen patients were included (57% male, age 62 ± 14 years), of whom 71% were dialyzed via an arteriovenous fistula. The mean time on dialysis was 51 ± 32 months. Convective volume achieved with Max-Sub biocontrol (Surdial X monitor) was higher than that achieved with UltraControl biocontrol (Artis monitor) (31 ± 2 vs. 29.4 ± 2.2 L/session, p = 0.009) and AutoSub+ biocontrol (6008 monitor) (31 ± 2 vs. 28.9 ± 2.6 L/session, p = 0.01). On multivariate analysis, factors associated with higher convective volume were the prescription of Max-Sub biocontrol (B 1.61, 95% CI [0.41-2.80], p = 0.009), TPM (B 0.02, 95% CI [0.01-0.03], p = 0.018), blood processed (B 0.17, 95% CI [0.08-0.26], p < 0.001), and not having diabetes mellitus (B -1.66, 95% CI [-2.72 to 0.59], p = 0.002).

Conclusion: The volume achieved by convective transport can vary according to the type of biocontrol, with Max-Sub performing the best out of the 3 biocontrol systems.

Keywords: Automatic system; Convective transport; Dialysis monitor; Hemodiafiltration; Hemodialysis; Post-dilution.

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Conflict of interest statement

P.M.R. reports honoraria for conferences from Esteve, Vifor-Pharma, and Nipro. P.S. reports honoraria for conferences, consulting fees, and advisory boards from Amgen, Astellas, Astra Zeneca, Baxter, Braun, Fresenius, Nipro, and Vifor-Pharma. B.Q. reports honoraria for conferences, consulting fees, and advisory boards from Bayer, Novo Nordisk, Genzyme-Sanofi, AstraZeneca, Boehringer Ingelheim, and CSL-Vifor.

Figures

Fig. 1.
Fig. 1.
Study design.
Fig. 2.
Fig. 2.
Differences in infusion volume and total convective volume between the different biocontrols.
Fig. 3.
Fig. 3.
Correlations between convective volume and TMP (a) and blood processed (b).
See this image and copyright information in PMC

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