Background: Continuous monitoring of pre-/post-dialyzer pressure difference (ΔP) is widely used in continuous renal replacement therapies to monitor extracorporeal circuit function. The aim of this study was to verify whether ΔP may help to identify chronic subclinical worsening of dialysis quality due to incomplete dialyzer clotting in intermittent hemodialysis. Methods: Nine chronic hemodialysis patients were enrolled in the study and dialyzed twice (high-flux polysulfone dialyzer) with ΔP and urea-clearance monitoring: the first session with a standard anticoagulation and the second without. To verify whether a visible clotting of the dialyzer precedes or follows a significant ΔP increase, we checked the dialyzers for the presence of red clots after a saline flush performed when a 50% increase in ΔP was registered. Results: In the second dialysis session after a 50% increase in ΔP (documented in 7/9 patients), all dialyzers, after saline flush, showed a visible fiber clotting but not a significant reduction (>15%) in urea clearance. In the majority of the patients (6/7), until a few minutes before complete occlusion of the extracorporeal circuit, the urea clearance did not change significantly (–8.9 ± 12.7%). Conclusions: The usual check of the presence or absence of red clots in the dialyzer at the end of the dialysis session is enough, in the absence of red clots, to ensure that dialyzer efficiency is maintained during the whole treatment. Contrary to what is applied in CRRT, a continuous monitoring of ΔP during intermittent hemodialysis would not significantly help to unmask unnoticed inefficient hemodialysis sessions.

Keywords:
Pressure difference, Dialyzer, Intermittent hemodialysis, Clotting, Urea clearance, Dialysis efficiency
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© 2003 S. Karger AG, Basel
2003
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