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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">On-line haemodiafiltration &#40;OL-HDF&#41; is the most complete haemodialysis &#40;HD&#41; technique currently available&#44; since it is capable of eliminating a significant amount of low&#44; medium&#44; and large molecular weight uraemic toxins&#44; with direct relation to the volume of convective transport achieved&#46;<span class="elsevierStyleSup">1</span> Traditional HD&#44; in contrast&#44; only eliminates small molecules and a small amount of mid-sized molecules&#46; These cleansing benefits have a monetary cost similar to high-flux HD&#46;</p><p class="elsevierStylePara">Recent studies have demonstrated significant improvements in the survival of patients that achieve a high number of convective transport litres per OL-HDF session&#46; The results from the DOPPS<span class="elsevierStyleSup">2</span> observational study showed that patients on OL-HDF with more than 15l&#47;session had a 35&#37; higher survival rate than those with a lower rate&#46; In 2011&#44; two different randomised studies were presented&#46; In the CONTRAST study&#44;<span class="elsevierStyleSup">3</span> patients that achieved more than 20&#46;3l&#47;session had a higher survival rate &#40;hazard ratio &#91;HR&#93;&#58; 0&#46;66&#41;&#44; primarily by reducing the rate of cardiovascular mortality &#40;HR&#58; 0&#46;66&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41; &#40;HR&#61;0&#46;41&#41;&#46; The Turkish HDF Study&#44;<span class="elsevierStyleSup">4</span> which demonstrated that the convective transport volume necessary to reduce mortality was situated at a volume of infusion &#40;Vinf&#41; of 17&#46;4l&#47;session &#40;HR&#58; 0&#46;54&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46; These results indicate that a Vinf value greater than 20l should be the goal for post-dilutional OL-HDF &#40;post-OL-HDF&#41;&#44; in the absence of an established ceiling value above which no greater value is obtained&#46;</p><p class="elsevierStylePara">The difficulty in reaching these volumes in post-OL-HDF lies in the technical problems that haemoconcentration causes&#46; In order to avoid this issue&#44; a maximum ratio of 25&#37; between the ultrafiltration flow rate &#40;UFR&#41; and the blood flow &#40;Qb&#41; rate is deemed safe&#44; this ratio being the filtration fraction &#40;FF&#41;&#44; see Appendix 1 for an explanation of abbreviations&#46; In this manner&#44; Qb is a limiting factor for achieving the target Vinf&#44; along with the length of the session&#46; For example&#44; if the actual Qb is 250ml&#47;min for a 240min session&#44; Vinf would be 15l&#44; far below the goal of 20l&#47;session&#46; Currently&#44; as a result of optimising Qb and the length of dialysis sessions&#44; we have automated post-dilutional OL-HDF techniques that aid in reaching optimal convective transport values&#46; Despite the importance of these systems&#44; they are poorly represented in the medical literature &#40;for example&#44; the Fresenius<span class="elsevierStyleSup">&#174;</span> system&#41;&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Gambro<span class="elsevierStyleSup">&#174;</span> has developed an automatic post-OL-HDF system called Ultracontrol<span class="elsevierStyleSup">&#174;</span> &#40;UltraC&#41;&#46; It is based on a pressure-control system that allows for establishing the trans-membrane pressure &#40;TMP&#41;&#44; see Appendix 2&#46; In the pressure-control system&#44; TMP is constant and the infusion flow &#40;inF&#41; varies&#44; generally decreasing based on the conditions of the membrane and dialyser as the dialysis session progresses&#46; With UltraC&#44; biosensors detect changes induced in the UFR when TMP increases &#40;Figure 1&#41;&#46; If the increase in UFR is significant&#44; the change is maintained&#59; if the increase in TMP does not favour an increase in UFR&#44; then that pressure is the one established&#46; In a traditional volume control system&#44; UFR is fixed&#44; and when this level is high&#44; the pressure will increase&#44; generating alarms and other problems throughout the dialysis session&#46; As such&#44; the fundamental advantage to an automated treatment of this type is that the post-OL-HDF produces better results without generating TMP alarms or coagulations in the dialyser&#46;</p><p class="elsevierStylePara">In post-OL-HDF&#44; not only must the rheological characteristics of the patient&#8217;s blood be taken into account&#44; but also the hydraulic condition of the dialyser&#46; These characteristics are determined by the membrane as well as the capillary and dialyser design&#44; since these are the factors that determine the pressures maintained throughout the dialyser&#46; As observed in the Hagen-Poiseuille formula &#40;Appendix 3&#41;&#44; the internal radius of the capillary &#40;raised to the fourth power&#41; is a determining factor&#44; since small changes in diameter produce large changes in pressure&#46;<span class="elsevierStyleSup">6</span> As such&#44; the design of the dialyser is fundamental for a technique such as the UltraC to work properly&#44; with the goal of optimising effectiveness&#44; avoiding alarms&#44; and facilitating the work of the nursing staff&#46;</p><p class="elsevierStylePara">With this perspective&#44; the objective of our study was to evaluate the UltraC as a post-OL-HDS technique&#46; Firstly&#44; we sought to assess the output of this unit&#44; expressed as FF and Vinf&#44; testing whether FF exceeded the value of 25&#37; from the traditional system and if Vinf was higher than 20l&#46; Secondly&#44; we analysed how the UltraC adapts to four different dialysers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">We performed a prospective&#44; observational study in two parts&#46; In both&#44; all patients received treatment three days per week with a mean duration of 240 minutes per session &#40;range&#58; 225-300 minutes&#41;</p><p class="elsevierStylePara">The abbreviations used and their definitions are summarised in Appendix 1&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Part one&#46; Evaluation of FF and Vinf achieved using UltraC</span></p><p class="elsevierStylePara">We examined 9 patients &#40;7 men and 2 women&#44; mean age of 60 &#91;13&#93; years&#44; mean weight of 76 &#91;9&#93; kg&#41; that had been undergoing high-flux HD treatment for more than 3 months&#44; and that were transferred to post-OL-HDF due to medical indications&#46; We compiled all high-flux HD sessions corresponding to the previous month and the first three months on OL-HDF&#46; All patients had an arteriovenous fistula as a vascular access point&#46;</p><p class="elsevierStylePara">All patients were dialysed on machines using UltraC&#44; AK200US<span class="elsevierStyleSup">&#174;</span>&#46; We used the same high-flux dialyser as when patients were on HD &#40;Polyflux210H<span class="elsevierStyleSup">&#174;</span>&#41;&#44; as well as the same Qb&#44; Qd&#44; duration of sessions&#44; and all other dialysis characteristics&#46; The value used for Qb was the maximum value allowed by the vascular access&#44; without allowing pressure in the arterial line to drop below 220mm Hg&#46;</p><p class="elsevierStylePara">During each session&#44; the following variables were collected&#58; Qb ml&#47;min&#44; CBV &#40;l&#47;session&#41;&#44; UFV &#40;l&#47;session&#41;&#44; maximum inF &#40;ml&#47;min&#41;&#44; Vinf &#40;l&#47;session&#41;&#44; UFVt &#40;l&#47;session&#41;&#44; KT &#40;l&#47;session&#44; ionic dialysance&#41;&#44; TMP &#40;mm HG&#41;&#44; Psyst &#40;mm Hg&#41;&#44; and all complications derived from the technique used and coagulation that occurred during the first three months of treatment&#46;</p><p class="elsevierStylePara">We evaluated whether FF was superior to the rate of 25&#37; reached in the traditional volume-control technique&#44; and if Vinf was greater than 20l&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Part two&#46; Usefulness of UltraC using different dialysers</span></p><p class="elsevierStylePara">We evaluated 18 patients &#40;17 men and 1 woman&#44; mean age of 66 &#91;75&#93; years&#41; that had been undergoing chronic post-OL-HDS treatment for more than 3 months on AK200US<span class="elsevierStyleSup">&#174; </span>machines&#46; Vascular access was achieved using a tunnelled catheter in three&#46;</p><p class="elsevierStylePara">All patients underwent dialysis for one week using each of the different dialysers mentioned in Table 1&#44; while maintaining all other dialysis parameters constant&#46;</p><p class="elsevierStylePara">In each session&#44; the following variables were measured&#58; Psyst&#44; TMP&#44; Vinf&#44; KT&#44; the number of times the UltraC had to be withdrawn&#44; filter coagulations&#44; and haemoglobin and protein levels from the first week&#46;</p><p class="elsevierStylePara">In both parts of the study&#44; we calculated FF&#46;</p><p class="elsevierStylePara">In all cases&#44; the nursing staff connected the UltraC system at the start of the post-OL-HDF session&#44; fixing the alarm systems for TMP&#62;300 or Psyst&#62;700mm Hg&#46; When an alarm was triggered and the problem was not resolved&#44; UltraC was withdrawn and the patient was transferred to a pressure-control system&#44; which maintained the TMP at a fixed level at values that ensured a Psyst&#60;700mm Hg and an appropriate inF&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">All data were registered in a database for statistical analysis using SPSS software&#44; version 15&#46;0&#46; We presented data as means and standard deviations &#40;SD&#41;&#46; We compared groups using paired sample analyses &#40;paired t-test and Friedman&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Part one&#46; Evaluation of FF and Vinf achieved using UltraC</span></p><p class="elsevierStylePara">In six patients&#44; UltraC worked without incidents&#44; and technical problems arose in three patients&#44; two of which were associated with Psyst greater than 700mm Hg&#44; and one of which was due to a TMP greater than 300mm Hg&#46; These three patients were transferred to pressure-control systems&#46; After this adjustment&#44; the number of incidents per session in all nine patients was &#60;5&#37;&#46;</p><p class="elsevierStylePara">The results obtained in all nine patients during the first and third months are compiled in Table 2&#46;</p><p class="elsevierStylePara">The mean values obtained during these three months were&#58; maximum Qb&#58; 441 &#40;21&#41; ml&#47;min &#40;range&#58; 350-490&#41;&#44; CBV&#58; 96&#46;2 &#40;7&#46;7&#41; l&#47;session&#44; UFV&#58; 3&#46;2 &#40;0&#46;8&#41; l&#47;session&#44; Vinf&#58; 26&#46;3 &#40;3&#46;3&#41; l&#47;session&#44; UFVt&#58; 29&#46;5 &#40;3&#46;4&#41; l&#47;session&#44; FF&#58; 30&#46;6 &#40;2&#46;5&#41; &#37;&#44; maximum TMP&#58; 190&#46;8mm Hg &#40;range&#58; 125-301&#41;&#44; maximum Psyst&#58; 496&#46;5 &#40;94&#46;6&#41; mm Hg&#46; KT was 12&#37; higher than in high-flux HD &#40;53&#46;8 &#91;5&#46;1&#93; l&#47;session vs 59&#46;9 &#91;5&#93; l&#47;session&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Part two&#46; Usefulness of UltraC using different dialysers</span></p><p class="elsevierStylePara">The mean values and ranges of Hb and proteins were&#44; respectively&#44; 12&#46;1 &#40;10&#46;5-13&#46;7&#41; and 6&#46;4 &#40;5&#46;9-7&#46;3&#41; g&#47;dl&#46; Maximum Psyst and TMP values appear in Table 3&#46; Results were significantly different from those using the Elisio dialyser&#46;</p><p class="elsevierStylePara">The UltraC had to be withdrawn in all sessions in nine&#44; eight&#44; four&#44; and two patients when using the Elisio&#44; FX 1000&#44; FX800 and Polyflux dialysers&#44; respectively&#46; The dialyser that required the fewest transfers from UltraC to pressure-control systems was the Polyflux machine&#44; followed by FX and Elisio&#46; The mean number of sessions in which UltraC had to be withdrawn appears in Table 4&#46;</p><p class="elsevierStylePara">Despite the switch to pressure-control&#44; the use of all dialysers produced adequate values of Vinf and KT &#40;Table 3&#41;&#44; with no differences in the number of coagulations of the system&#46; The highest values were achieved using the FX1000 dialyser&#44; and the lowest values using the FX800&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Our study shows how the UltraC automated system can achieve infusion volumes of 26l and FF far greater than 25&#37; in four hours of dialysis&#44; with only a small number of alarms&#44; which facilitates the application of this technique and ensures good quality of the dialysis provided&#46; If we add to these values the UF used to maintain dry weight&#44; the convective transport volumes reach 30l per session&#46; With this volume&#44; patients clearly surpass the 20l value which&#44; according to previously cited studies&#44; implies benefits to survival using these convective techniques&#46;</p><p class="elsevierStylePara">UltraC periodically measures TMP and adjusts UFR&#44; which provides an &#8220;individualised&#8221; treatment in which the dialysis machine adapts to each patient and the changes that are produced throughout the session&#46; This adjustment produces a maximum Vinf that is superior to the value reached using traditional OL-HDF&#44; in which a blood flow percentage is predetermined &#40;with UltraC&#44; we can reach an FF of almost 30&#37; Qb&#41;&#46;</p><p class="elsevierStylePara">The information provided by measuring Psyst is essential&#46; The use of Psyst would cause TMP to be overestimated and would result in a reduced margin of error for this technique&#46; Its use as an external source of information provides clues as to the changes within the dialyser throughout the session that might lead to coagulation&#44; and allows us to anticipate events that would not be detectable with TMP alone&#46; The measurement of Psyst favours earlier response by the nursing staff to avoid continuous alarms&#44; coagulation of the system&#44; and to achieve proper Vinf&#46;</p><p class="elsevierStylePara">Only one study by Teatini et al describes the efficacy of using the UltraC system and its practical use&#46;<span class="elsevierStyleSup">7</span> This study clearly shows the advantages of using a system such as UltraC&#44; although the Vinf values reached are lower than we achieve in daily clinical practice&#44; since they worked with Qb values lower than 300ml&#47;min&#46; In this publication&#44; the role of Psyst in the functioning of this system is not well elaborated&#44; with results for only one dialyser&#44; which is an unusual situation in the daily practice of dialysis units&#44; where various dialysers are commonly used&#46; The results from this study&#44; with the Vinf values reached&#44; made us reflect on the need to take into account all the elements that we can modify to reach Vinf values greater than 20l&#46; Although we may be using a very good technique&#44; it might not be profitable if it does not reach the Qb values necessary for a high UFR&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">There is also very little in the medical literature dedicated to other automated systems such as the Fresenius<span class="elsevierStyleSup">&#174;</span> system&#44; which facilitates an automatic inF prescription if total protein and haematocrit values are specified&#46; With this application&#44; we can also achieve a greater inF&#44; with increased convective transport while maintaining the same risk of alarms&#44; which lends greater support to these automated systems&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The second part of our study shows that although we obtained adequate KT and Vinf values in all dialysers&#44; the number of alarms was slightly different between systems&#46; These alarms required the transfer from UltraC to pressure-control systems&#44; which increases the work load needed and underlines the importance of choosing the best dialyser for the technique used&#46; The Polyflux dialyser&#44; which is also designed by Gambro&#44; was the design that produced the fewest number of alarms and was best adapted to the technique&#44; as expected&#46; In contrast&#44; the Elisio dialyser design&#44; with a tighter and longer fibre diameter that is optimal for a high-flux HD unit and pressure-control systems&#44; is not well-suited for use with UltraC&#46; As mentioned previously&#44; the AK-200US provides an additional piece of information in the form of Psyst&#44; and the Elisio dialyser resulted in extremely high Psyst values even in the first hour of the dialysis session&#44; requiring a switch to pressure-control dialysis even though TMP values were not high&#46; These Psyst alarms were a consequence of the design of the dialyser&#44; since the Hagen-Poiseuille equation states that a smaller fibre radius induces higher pressure&#46; In contrast&#44; in other dialysers such as the Polyflux&#44; Psyst continued to increase throughout the session&#44; which indicated changing conditions within the filter and anticipated the possible partial or total coagulation of the filter&#46; In this manner&#44; Psyst offers information in addition to TMP&#44; which aids in preventing complications&#46; In other machines&#44; such as the 5008&#44; Psyst is integrated into the value of TMP&#44; although this information is not provided to the user&#46;</p><p class="elsevierStylePara">In any case&#44; although the number of alarms was high with UltraC&#44; forcing a switch to pressure-control systems&#44; the efficacy of the technique was good&#44; since we obtained adequate Vinf and KT values using all dialysers&#46; The differences shown in these parameters in favour of the FX1000 dialyser are attributable to the fact that this dialyser has a larger surface area than the others&#44; and the opposite is true in the smaller FX800&#46; Clearly&#44; the type of dialyser used is a determining factor in these techniques&#46; Small changes in fibre diameter will influence the number of alarms produced&#44; and small changes in surface area will produce changes in KT and Vinf that&#44; although may seem irrelevant&#44; involve an increase in the weekly dialysis dosage administered and&#44; probably&#44; will have long-term effects on survival&#46; These findings make us reflect on the need for maximum payoff from the devices used in daily practice&#44; which can be achieved by understanding the technical specifications and optimal use of each&#44; since the characteristics of these systems are not solely determined by their composition&#46;<span class="elsevierStyleSup">9</span> In this manner&#44; although all of the dialysers used in our study were effective from a practical point of view&#44; the dialyser best suited for use with the UltraC system is the Polyflux&#44; and a pressure-control system should be used in the case of other types of dialysers in order to reduce the number of alarms produced&#46;</p><p class="elsevierStylePara">One last technical aspect of OL-HDF that we would like to comment on is the loss of albumin&#46; This loss depends on the type of dialyser&#44;<span class="elsevierStyleSup">10&#44;11</span> but some authors also relate this phenomenon to the application of a high TMP during the first 30 minutes of OL-HDF&#46;<span class="elsevierStyleSup">12 </span>The UltraC system normally starts with a TMP that increases progressively during the first 30 minutes&#44; in an attempt to avoid this complication&#46;</p><p class="elsevierStylePara">In addition to the technical objectives of this study&#44; making post-OL-HDF easily applicable is a fundamental step in facilitating its widespread use&#46; As such&#44; the number of alarms produced must be minimised in order to facilitate the work of the nursing staff&#46; From this point of view&#44; UltraC fulfils expectations&#44; since the system is easily transferable to pressure-control when alarms appear&#44; and indicates the proper TMP that needs to be set in order to achieve a proper Vinf&#46;</p><p class="elsevierStylePara">In conclusion&#44; UltraC is the optimal system for achieving Vinf levels greater than 20l&#46; Dialysers with adequate purifying capabilities may not be useful for use in OL-HDF with UltraC because their flow and dynamic characteristics generate high Psyst values that impede automated use&#44; although the final outcome may be similar&#46; An adaptation of existing dialysers to this technique would aid nursing staff&#44; facilitating an improved and more widespread use of OL-HDF&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">Dr&#46; M&#46; Albalate has participated as a speaker in meetings organised by Gambro<span class="elsevierStyleSup">&#174;</span> y Fresenius<span class="elsevierStyleSup">&#174;</span>&#46;</p><p class="elsevierStylePara">Dr&#46; R&#46; P&#233;rez Garc&#237;a and Dr&#46; P&#46; de Sequera have participated as speakers in meetings organised by Gambro<span class="elsevierStyleSup">&#174;</span>&#44; Fresenius<span class="elsevierStyleSup">&#174;</span> and Bellco<span class="elsevierStyleSup">&#174;</span>&#44; and work as advisors for FMC&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgements</span></p><p class="elsevierStylePara">We would like to thank the nursing staff at the Haemodialysis Unit of the Infanta Leonor Hospital&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;16025&#95;24053&#95;en&#95;t1&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_16025_24053_en_t1_11122.jpg" alt="Technical specifications for the dialysers"></img></a></p><p class="elsevierStylePara">Table 1&#46; Technical specifications for the dialysers</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24054&#95;en&#95;tabla&#95;2&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24054_en_tabla_2_11122.gif" alt="Results from the use of OL-HDF with UltraC for three months"></img></a></p><p class="elsevierStylePara">Table 2&#46; Results from the use of OL-HDF with UltraC for three months</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24055&#95;en&#95;tabla&#95;3&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24055_en_tabla_3_11122.gif" alt="Results from the use of UltraC with different dialysers"></img></a></p><p class="elsevierStylePara">Table 3&#46; Results from the use of UltraC with different dialysers</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24056&#95;en&#95;tabla&#95;4&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24056_en_tabla_4_11122.gif" alt="UltraC withdrowal according to the type of dialyser used"></img></a></p><p class="elsevierStylePara">Table 4&#46; UltraC withdrowal according to the type of dialyser used</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24057&#95;en&#95;figura&#95;1&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24057_en_figura_1_11122.jpg" alt="Schematic of the functioning of UltraC"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Schematic of the functioning of UltraC</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24058&#95;en&#95;anexo&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24058_en_anexo_11122.jpg" alt="Abbreviations and definitions"></img></a></p><p class="elsevierStylePara">Abbreviations and definitions</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24059&#95;es&#95;anexo&#95;2&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24059_es_anexo_2_11122.jpg" alt="Functioning of the UltraC system"></img></a></p><p class="elsevierStylePara">Functioning of the UltraC system</p><p class="elsevierStylePara"><a href="grande&#47;11122&#95;108&#95;24060&#95;en&#95;anexo&#95;3&#95;11122&#46;jpg" class="elsevierStyleCrossRefs"><img src="11122_108_24060_en_anexo_3_11122.jpg" alt="Hagen-Poiseuille equation"></img></a></p><p class="elsevierStylePara">Hagen-Poiseuille equation</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58; </span>Estudios recientes indican que los beneficios en la supervivencia con hemodiafiltraci&#243;n en l&#237;nea posdilucional &#40;HDFOL-post&#41; se logran si el volumen de infusi&#243;n &#40;Vinf&#41; es superior a 20 l por sesi&#243;n&#44; cifra que no es f&#225;cil lograr por los problemas que genera la hemoconcentraci&#243;n&#46; Hoy d&#237;a contamos con t&#233;cnicas autom&#225;ticas que logran un mayor rendimiento minimizando el n&#250;mero de alarmas como el Ultracontrol<span class="elsevierStyleSup">&#174; </span>&#40;UltraC&#41;&#46; <span class="elsevierStyleBold">Objetivo&#58; </span>El objetivo ha sido&#44; en una primera parte&#44; evaluar el UltraC para conocer qu&#233; rendimiento logra &#40;expresado como la fracci&#243;n de filtraci&#243;n &#91;FF&#93; y el Vinf&#41; y los problemas que presenta y&#44; en una segunda parte&#44; estudiar su funcionamiento con cuatro dializadores diferentes&#46; <span class="elsevierStyleBold">Material y m&#233;todos&#58; </span><span class="elsevierStyleItalic">Primera parte&#46; </span>Nueve pacientes fueron transferidos a HDFOL-post con UltraC&#46; Se recogieron todas las sesiones correspondientes a los tres primeros meses con HDF-OL y al mes previo en HD&#46; <span class="elsevierStyleItalic">Segunda parte&#46; </span>18 pacientes en tratamiento cr&#243;nico con HDFOL-post fueron sometidos a di&#225;lisis una semana con cada uno de estos dializadores&#58; FX1000&#44; FX800&#44; Polyflux210 y Elisio 210H&#46; <span class="elsevierStyleBold">Resultados&#58; </span><span class="elsevierStyleItalic">Primera parte&#46; </span>En 3 pacientes surgieron problemas asociados a PTM y Psist inadecuadas que se resolvieron pasando a control-presi&#243;n&#46; Los valores medios obtenidos fueron&#58; Qb m&#225;ximo 441 &#40;21&#41; &#40;rango 350-490&#41; ml&#47;min&#44; Vinf 26&#44;3 &#40;3&#44;3&#41; l&#47;sesi&#243;n&#44; FF 30&#44;6&#37; &#40;2&#44;5&#41;&#44; KT 59&#44;9 &#40;5&#41; l&#47;sesi&#243;n&#44; y aumento del KT del 12&#37; respecto al de HD&#46; <span class="elsevierStyleItalic">Segunda parte&#46; </span>Polyflux210 fue el dializador que precis&#243; menos retiradas de UltraC&#46; Las presiones recogidas tanto PTM como Psist fueron distintas y determinaron la necesidad de retirada del sistema&#46; El KT fue adecuado&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span><span class="elsevierStyleItalic">a&#41; </span>El sistema UltraC alcanza FF del 30&#37; consiguiendo Vinf adecuados con m&#237;nimas alarmas&#44; y <span class="elsevierStyleItalic">b&#41; </span>Dializadores con prestaciones depurativas adecuadas pueden no ser &#250;tiles para realizar HDF-OL con UltraC porque sus condiciones flujodin&#225;micas generan alarmas que impiden la aplicaci&#243;n automatizada aunque el rendimento final sea semejante&#46;</p>"
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