Daily use of the physio dialysis system: Long‐term experience

SummaryBackground: Hypovolaemia has been implicated as a major causal factor of morbidity during haemodialysis (HD). In order to avoid the appearance of destabilising hypovolaemia a biofeedback control system for intra‐HD blood volume (BV) change modelling has been developed (Hemocontrol™, Hospal Italy). It is based on an adaptive controller incorporated into a HD machine (Integra™, Hospal Italy). The Hemocontrol™ biofeedback system (HBS) monitors BV contraction during HD with an optical device; furthermore, HBS modulates BV contraction rates (by adjusting the ultrafiltration rate — UFR) and the refilling rate (by adjusting dialysate conductivity — DC) in order to obtain the desired pre‐determined BV trajectories.Methods: Nineteen patients prone to hypotension (7 males, 12 females, mean age 64.5 ± 3.0 SEM years, on maintenance HD for 80.5 ± 13.2 months) volunteered for the prospective study which aimed to compare the efficacy and safety of bicarbonate HD treatment equipped with HBS, as a whole (HBS), with the gold standard, bicarbonate treatment, equipped with a constant UFR and DC (BD). The study included one period of 6 months of BD always preceding a follow‐up period of HBS treatment ranging from 14 to 30 months (mean 24.0 ± 1.6).Results: The overall occurrence of symptomatic hypotension and muscle cramps was significantly less in HBS treatment. Self‐evaluation of intra‐ and inter‐HD symptoms (the worst score was 0 and the best one 10) did reveal a statistically significant difference, as far as post‐HD fatigue is concerned (6.2 ± 0.2 in HBS vs. 4.3 ± 0.1 in BD treatment, p < 0.0001). No difference between the two treatments was observed when comparing pre‐ and post‐HD lying blood pressure, heart rate, body weights and body weight changes.Conclusions: HBS is an effective treatment. Hypovolaemia‐associated morbidity occurs less in BD treatment than HBS. Furthermore, HBS is a safe treatment in the medium‐term because these results are achieved without potentially harmful changes in blood pressure, body weight and serum sodium concentration.