Restless legs syndrome effectively treated with constant-pressure predilution online hemodiafiltration

  • Shunichiro UrabeEmail author
  • Takashi Hosono
  • Toru Hyodo
  • Makoto Kitamura
  • Miho Hida
  • Yasuhisa Kurata
  • Kenichi Kokubo
Case Report Artificial Kidney / Dialysis



We encountered a case of unstable predilution online HDF due to elevated transmembrane pressure (TMP) when performing constant-speed predilution online hemodiafiltration (HDF) as treatment for restless legs syndrome (RLS) in a dialysis patient. We report the effectiveness of incorporating a newly developed constant-pressure predilution online HDF system as a preventive measure against unstable online HDF and frequent adjustment of settings when treating dialysis patients with RLS.

Case presentation

A 55-year-old man had suffered from RLS and been undergoing constant-speed online HDF with 45 L target predilution and an ABH-21P hemodiafilter. The symptoms of RLS rated 10 on the International Restless Legs Syndrome Rating Scale (IRLS). The α1-microglobulin (α1-MG) removal rate was only 27.8%, so the hemodiafilter was subsequently replaced with a PEPA hemodiafilter. However, episodes of elevated TMP exceeding 250 mmHg occurred frequently after the replacement and were managed by reducing dialysate flow rate. Therefore, we incorporated a constant-pressure predilution online HDF that maintains TMP below 200 mmHg. The amount of replacement was maintained at approximately 43.5 ± 6.98 L and the α1-MG removal rate was 39.5%, with no need to manually reduce the flow rate. The Alb leakage in dialysate waste was 7.9 g. The patient has maintained an IRLS rating of 0 with no RLS symptoms for the past 4 years.


Using the constant-pressure mode enabled achieved the clinical endpoint, namely, resolution of RLS with no need to manually reduce the flow rate.


Online HDF Restless legs syndrome Constant-pressure predilution 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest


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Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  • Shunichiro Urabe
    • 1
    Email author
  • Takashi Hosono
    • 1
  • Toru Hyodo
    • 2
  • Makoto Kitamura
    • 3
  • Miho Hida
    • 3
  • Yasuhisa Kurata
    • 3
  • Kenichi Kokubo
    • 4
  1. 1.Department of Clinical EngineeringEijin ClinicHiratsukaJapan
  2. 2.Eijin ClinicHiratsukaJapan
  3. 3.Kurata HospitalHiratsukaJapan
  4. 4.Kitasato University School of Allied Health SciencesSagamiharaJapan

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