Dialysis Techniques by Neelam verma

16/11/2025

OL-HDF (Online Hemodiafiltration)

“Advanced renal replacement therapy combining diffusion + convection

1. What is OL-HDF?

OL-HDF is a dialysis therapy where ultrafiltration (UF) and online-generated replacement fluid are used to remove small + middle + large toxins more effectively than regular HD.

It combines:
• Hemodialysis (Diffusion): Clears small molecules like urea, creatinine
• Hemofiltration (Convection): Clears larger molecules like β2-microglobulin, cytokines

2. Key Requirements for OL-HDF

Requirement

Details
High-Flux Dialyser

FX-Series (Helixone® membrane)

High Water Quality
Ultrapure dialysate
Online Substitution Fluid
Automatically produced inside 5008S
High Blood Flow
≥350mL/min

Convective Volume
Target: >23L/session

3. Types of OL-HDF

✔ Post-dilution OL-HDF (most common)

Replacement fluid is infused after the dialyser
• Best clearance
• Requires good vascular access

✔ Pre-dilution OL-HDF

Fluid infused before the dialyser
• Used when Access pressures are low
• Higher substitution volume required

4. Clinical Benefits of OL-HDF

✔ Better toxin removal

• Middle molecules
• Inflammatory mediators
• β2-microglobulin

✔ Better haemodynamic stability

• Fewer hypotension episodes

✔ Improved patient outcomes

• Reduced hospitalisation
• Lower inflammation
• Improved quality of life

✔ Better phosphate removal

5. Why 5008S is best for OL-HDF
• Helixone plus membrane dialysers
• High substitution volume capability
• Online production of sterile, non-pyrogenic substitution fluid
• AutoSub plus technology
• Better control of TMP & UF

6. What Technicians Must Check
• Dialyser: FX100 / FX80 / FX60
• Blood flow: ≥300 mL/min
• TMP: Normal range
• Substitution flow: Automatic
• Target convection volume: 22–25 L (post-dilution)
• Ensure no alarms:
• TMP high
• Blood leak
• Gravimetric UF issue

14/11/2025

14/11/2025

MFT pro CRRT machine- The machine is designed for continuous renal replacement therapy (CRRT) in critically ill patients, especially in ICU settings. 
• It supports multiple modalities: e.g., CVVHD, CVVH, CVVHDF (and variants with pre/post dilution) with blood flow up to ~500 mL/min. 
• It has options for advanced anticoagulation: notably regional citrate anticoagulation (Ci-Ca) in addition to heparin. 
• Designed for ICU use: integrates data connectivity (e.g., HL7), supports combination therapies (e.g., TPE, adsorption, ECCO2R) as described by the manufacturer.

21/09/2025

An honor to be a speaker on Online HDF at the prestigious IADTCON 2025, hosted at Amrita Hospital, Faridabad.
A wonderful platform to share knowledge and connect with passionate dialysis technologists from across the country

Grateful to Fresenius Medical Care for driving innovation and supporting better patient outcomes.
# 5008s Machine

31/03/2025

Continuous Renal Replacement Therapy (CRRT) with hemoperfusion is a specialized blood purification technique used in critically ill patients, especially those with sepsis, multi-organ failure, or severe drug/toxin overdoses. It combines CRRT, which provides slow and continuous removal of solutes and fluids, with hemoperfusion, which helps remove inflammatory mediators, toxins, or endotoxins using adsorption filters.

Key Components of CRRT with Hemoperfusion:
1. CRRT (Continuous Renal Replacement Therapy)
• Modes: CVVH (convection), CVVHD (diffusion), CVVHDF (both convection & diffusion)
• Removes fluids and small-to-medium molecules (e.g., urea, creatinine, electrolytes)
2. Hemoperfusion
• Uses an adsorptive cartridge (e.g., polymyxin B, CytoSorb) to remove specific toxins or inflammatory mediators
• Targets cytokines (IL-6, IL-1, TNF-α) in septic patients
• Effective for drug overdoses (e.g., barbiturates, theophylline, paraquat poisoning)

Indications
• Sepsis with cytokine storm
• Acute poisoning (certain drugs or toxins)
• Severe inflammatory response syndrome (SIRS)
• Liver failure with hepatic encephalopathy
• Multi-organ dysfunction syndrome (MODS)

Benefits
• Enhances clearance of inflammatory mediators
• Improves hemodynamic stability in septic patients
• Potentially reduces vasopressor dependency

Would you like specific details on setup, filter types, or clinical protocols?

04/11/2024

Key Aspects of Sodium Profiling in the 4008S:

1. Purpose of Sodium Profiling:
• Helps prevent intradialytic hypotension (low blood pressure during dialysis) by modifying the sodium level in the dialysate, which can assist with osmotic stability.
• Reduces cramps, dizziness, and nausea by managing fluid shifts more smoothly.
2. Adjustable Sodium Levels:
• Allows the clinician to set a sodium profile, typically starting with a higher concentration and gradually lowering it throughout the session.
• For example, the sodium level may start around 145-155 mEq/L and gradually decrease to a standard level, often around 135-140 mEq/L.
3. Profile Options:
• Linear Profile: Sodium concentration decreases in a steady, linear manner throughout the session.
• Stepwise Profile: Sodium levels are adjusted in specific steps, allowing for more flexibility in tailoring the concentration at different points in the session.
• Individualized Profiles: Custom profiles can be set based on patient needs, such as high initial sodium for patients with frequent hypotension issues, followed by a gradual decrease.
4. Benefits of Sodium Profiling:
• Improved Patient Tolerance: Sodium profiling can make fluid removal more tolerable, especially in patients prone to hypotension.
• Enhanced Fluid Balance: Helps in maintaining osmotic balance, which reduces the risk of rapid fluid shifts that can lead to discomfort.
• Reduced Recovery Time: Patients may experience less post-dialysis fatigue or “dialysis hangover” due to improved fluid and electrolyte balance.
5. Monitoring and Safety:
• Sodium profiling must be used carefully, as excessive sodium levels can lead to sodium loading, which may increase thirst and result in higher interdialytic weight gain.
• Clinicians monitor patient response to sodium profiling closely to adjust for optimal

04/11/2024

Ultraflux EMiC 2 for the removal of middle molecules
In addition to the conventional goals of CKRT, such as the control of the fluid status and the correction of electrolyte abnormalities, an enhanced reduction of IL-6, IL-8, and myoglobin has been demonstrated using EMiC 211 in comparison to Ultraflux AV 1000

The high‑permeability hemofilter Ultraflux EMiC 2 is used in Ci‑Ca CVVHD treatments.

It can improve the removal of middle molecules exceeding the molecular weight of commonly known small-sized uremic toxins such as urea and creatinine, while retaining albumin.1‑5
Ultraflux EMiC 2 at a glance:
Clearance of middle molecules such as myoglobin or interleukin-62 Clearance has been demonstrated throughout citrate-anticoagulated CKRT for up to 72 hours