Comparative study of perdialytic volemia variability in chronic dialysis patients between acetate- free biofiltration and bicarbonate hemodialysis.

We have developed since 1994 a new hemodialysis (HD) technique called acetate biofiltration 84% (AFB 84%) that is characterized by the absence of acetate in the dialysate and the complete correction of buffer balance by post- dilutional infusion of bicarbonate- based replacement solution. Our study aimed to compare the variability of perdialytic volemia [net ultrafiltration (UF) rate, total UF, Δweight (T4- T0)] during AFB 84% and bicarbonate dialysis (BD) for stable chronic hemodynamic patients. This was a prospective crossover study carried out on 14 patients for a total of 168 HD sessions (84 AFB 84% and 84 BD). Optical measurement of hemoglobin (Hb) concentration was incorporated into the dialysis monitor to allow the study of the relative blood volume. For both techniques, Hb measured by Hemoscan® correlated well with the laboratory measurements. Moreover, the comparison of the averages of the different indicators of the perdialytic volemia did not disclose any significant statistical differences. Nevertheless, the comparison of the variability of perdialytic volemia between both techniques showed less Δ volemia (T4- T0) during the AFB 84% than the BD (- 7.909% for BD and - 6.960% for ABF 84%, P = 0.0036). We conclude that the absence of acetate and maintaining an optimal osmolarity at the origin of a better plasma refilling rate are key factors that make AFB 84% a technique assuring a better perdialyitic hemodynamic tolerance in comparison with BD in chronic HD patients.