Journal of Nephrology

, Volume 32, Issue 1, pp 151–154 | Cite as

Overcoming glucose delivery by on-line hemodiafiltration: a feasible chimera for diabetics on dialysis

  • Marco MaranoEmail author
  • Fabrizio Fanelli
Technical Note


The increasing number of patients with diabetes undergoing renal replacement therapy has raised interest in the issue of glucose delivery with the substitution fluid—over 20 g per session. The ideal situation would be to have a glucose-containing bath to avoid glycemic disarrays and a glucose-free substitution fluid. But this seems a chimera because the substitution fluid is nothing else than an ultrapure dialysis bath. In this technical note, we present a cheap solution to realize the desired mix, using a commercially available glucose-free dialysate and adding glucose in the inlet dialysate compartment of the dialyzer by means of a common pump and a unique handmade T-tube. Our in vitro experiments showed glucose levels in the dialysate (mean ± SD, mg/dl): 99.7 ± 4.6 at baseline, 100.7 ± 7.3 at mid-session and 100.7 ± 2.1 at the end of dialysis, whereas measurements in the substitution fluid always gave a “low” output (p < 0.0001). Similar results were obtained in single 1- and 4-h in vivo experiments carried out in a non-diabetic overweight hemodialysis patient. Our simple, yet unequivocal, results lay the foundation for assembling a hemodialysis machine equipped with an infusion pump to modify the on-line substitution fluid without affecting the dialysate. This would overcome the ethical issue of delivering glucose intravenously in certain groups of patients.


Diabetes Dialysis bath Glucose Hemodiafiltration Substitution fluid 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the only participant included in the study.


  1. 1.
    Burmeister JE, Scapini A, da Rosa Miltersteiner D, da Costa MG, Campos BM (2007) Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis. Nephrol Dial Transpl 22(4):1184–1189CrossRefGoogle Scholar
  2. 2.
    Pedrini LA, De Cristofaro V, Pagliari B, Ruggiero P (2002) Dialysate/infusate composition and infusion mode in on-line hemodiafiltration. Contrib Nephrol 137:344–349CrossRefGoogle Scholar
  3. 3.
    Canaud B, Barbieri C, Marcelli D, Bellocchio F, Bowry S, Mari F, Amato C, Gatti E (2015) Optimal convection volume for improving patient outcomes in an international incident dialysis cohort treated with on-line hemodiafiltration. Kidney Int 88(5):1108–1116CrossRefGoogle Scholar
  4. 4.
    Marano M (2018) On the advantage of glucose delivery by on-line hemodiafiltration. Ther Apher Dial. Google Scholar
  5. 5.
    Abe M, Kalantar-Zadeh K (2015) Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nat Rev Nephrol 11(5):302–313CrossRefGoogle Scholar
  6. 6.
    Henderson LW, Sanfelippo ML, Beans E (1978) “On line” preparation of sterile pyrogen-free electrolyte solution. Trans Am Soc Artif Intern Organs 24:465–467Google Scholar
  7. 7.
    Ledebo I (2002) On-line preparation of solutions for dialysis: practical aspects versus safety and regulations. J Am Soc Nephrol 13(Suppl 1):S78-83Google Scholar
  8. 8.
    Macías N, Vega A, Abad S, Santos A, Cedeño S, Linares T, García-Prieto AM, Aragoncillo I, Yuste C, López-Gómez JM (2017) Is high-volume on-line hemodiafiltration associated with malnutrition? Ther Apher Dial 21(4):361–369CrossRefGoogle Scholar
  9. 9.
    Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, Soler J, Torres F, Campistol JM, Martinez-Castelao A; ESHOL Study Group (2013) High-efficiency postdilution on-line hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 24(3):487–497CrossRefGoogle Scholar
  10. 10.
    Marano M, Cirillo G (2016) The forgotten issue of glucose delivery to diabetes patients in on-line hemodiafiltration. Ther Apher Dial 20(2):205CrossRefGoogle Scholar

Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  1. 1.Hemodialysis UnitMaria Rosaria ClinicPompeiiItaly
  2. 2.Technical Dialysis and Clinical Application Specialist Nipro Medical Europe Italian BranchMilanItaly

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