HEMODIAFILTRATION AS AN EMERGENCY METHOD: A PRACTICAL APPROACH FOR CRITICAL PATIENTS

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HEMODIAFILTRATION AS AN EMERGENCY METHOD: A PRACTICAL APPROACH FOR CRITICAL PATIENTS

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Co-author 1

HAMDOUS Sofiane hamdous.s722@gmail.com Nefissa Hamoud University Hospital Nephrology Algiers Algeria *

Co-author 2

SEDDIKI Cherif seddikicherif301@gmail.com Nefissa Hamoud University Hospital Nephrology Algiers Algeria -

Co-author 3

SEBAA Athmane sebaa.athmane64@gmail.com Nefissa Hamoud University Hospital Nephrology Algiers Algeria -

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Introduction

Hemodiafiltration (HDF) is traditionally used in chronic dialysis, but its superior hemodynamic tolerance and solute clearance make it a promising option for unstable patients. In our department, we applied HDF as an emergency technique for critical patients who could not tolerate conventional hemodialysis (HD) due to hemodynamic instability or rapid metabolic deterioration. This study aimed to describe our experience and evaluate the clinical and biochemical outcomes.

Methods

We retrospectively analyzed twelve consecutive patients treated with emergency HDF in our nephrology unit. The main indications were acute pulmonary edema, severe hyperkalemia, metabolic or lactic acidosis, and uremic symptoms. All patients were considered hemodynamically unstable or at high risk for HD intolerance. Pre- and post-dialysis biochemical values (urea, potassium, pH) were compared using the Wilcoxon test. Clinical tolerance and symptom improvement were assessed for each session.

Results

The mean age was 51.6 ± 18.1 years, with 75% males. Emergency HDF achieved rapid metabolic correction: urea decreased from 2.62 ± 1.09 to 1.59 ± 0.46 g/L (p < 0.001), potassium from 5.66 ± 1.43 to 4.11 ± 0.49 mmol/L (p = 0.001), and pH increased from 7.19 ± 0.19 to 7.38 ± 0.03 (p = 0.003). All sessions were well tolerated, with no major hemodynamic events. Most patients showed prompt clinical improvement, especially in respiratory and hemodynamic stability.

Conclusion

Our findings suggest that emergency HDF is a safe and effective option for critical or hemodynamically unstable patients who cannot tolerate conventional HD. It allows rapid metabolic correction with excellent tolerance, making it a valuable alternative in acute care nephrology.

Kewords