In India most of the dialysis centers use low flux dialyzers for the Dialysis process as a standard practice irrespective of the patient weight and for the no. of years he/ she is being on dialysis. Particularly in our country in most of the dialysis centers the role of nephrologist is just and only limited to verification of blood reports and accordingly prescribing the medication. Their role in dialysis unit is very less except only advising the patient if he needs the dialysis of 3 times or 2 times in a weak and about the need of EPO and Iron injections. As a standard practice many centers use Fresenius (F-6) Low-Flux dialyzers for either Bi-weekly or tri-weekly dialysis process. The entire dialysis process is simply left to the technicians who themselves don’t have much theoretical knowledge, so without doing much for customizing on patient requirements they simply set the machines at standard parameters and operate.
But in many developed countries, now high-flux hemodialysis is the most common mode of dialysis therapy. Its steadily increasing use is largely based on the desire to reduce the excessively high morbidity and mortality of end-stage renal disease patients comparing with the patients maintained on conventional dialysis (i.e. Low flux dialysis). Studies of medical research says for selected subgroups of high-flux dialysis patients by the use of High Flux dialyzers, the clearance of B2-microglobulin molecules, phosphorous, homocysteine is far high and this will protect the patient from the comorbidity conditions of primary decease like amyloidosis and Cardio vascular decease etc. So it may be concluded like the mortality of the patient is much better with the use of High flux dialyzers as compared to the use of standard low flux dialyzers of F-6 Class.
The major disadvantage of high-flux hemodialysis relates to the use of dialysis fluid, which is commonly not pure and may endanger patients treated with high-flux hemodialysis. Endotoxin fragments and other bacterial substances derived from bacteriologically contaminated dialysis fluid may (even at bacterial counts or endotoxin concentrations within the limits of accepted standards of dialysis fluid purity) enter from the dialysate into the patient's blood either by convective transfer (backfiltration) or by movement down the concentration gradient (backdiffusion). And this may cause severe infections.
After reading so much on internet about these articles, from some time I had been seriously thinking about switch over to use of high flux dialyzers. Recently I came to know that a great friend of me (who himself on dialysis) being started the use of high flux dialyzers. This I knew while I was reading his blog. Immediately I spoke to him and requested him if he can get one or two H.F.Dialysers for me. After convincing him, to switch over to this mode of dialysis, initially I got 2 numbers of “HF80S” Dialyzers from him. I need 12 to 13 Dialysis per month, so I decided to re-use this HF80S for six times and the remaining 6/7 with the regular F-6 Class low flux dialyzers. Till this everything was fine.
I have started using HF80S from 18/08/2012. Now all of sudden I have developed Cold, Cough and a very light fever with a bit of chills and this is all only after started using high flux dialyzer. Though I don’t have any solid evidence about the reason for this infection, still I am a bit worried if it might be due to the use of H.F.D. The reason for this is as I mentioned in the previous paragraph, when I use H.F.D., the quality of the water used for dialysis process shall be of ultra-pure quality. I have no guarantee for the quality of water that is being used in my Dialysis center. I strongly feel there is no control on it and hardly have they ever done the periodical testing to check the quality of the water.
For the last one year I have not been to any infections like this. Though I have been consulting my nephrologist time to time but that is only to show my blood reports and to get his advises on medication if any change that may be proposed by him. Otherwise I was normal. But as I got this viral infection now and again that is only after the use of H.F.D., I am a bit confused if to continue this mode of therapy or stop for some time?
Please advice....! Kamal, are you listening?
