Abstract: FR-PO787

Effects of Post-Dilution High Volumen On-line Hemodiafiltration in Comparison to High-Flux Hemodialysis: A One-Year Prospective and Controlled Study

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Hadad-Arrascue, Fernando F., Clinica RTS Murcia VII, Murcia, Spain
  • Pimentel, Gabriela I, Clinica RTS Murcia VII, Murcia, Spain
  • Fernandez-Lopez, Barbara, Clinica RTS Murcia VII, Murcia, Spain
  • Algaba, Maria D, Clinica RTS Murcia VII, Murcia, Spain
  • Poma tapia, Marisol, Hospital Universitario Clinico San Carlos, Madrid, Spain
Background

It is suggested that post-dilution on-line Hemodiafiltration (OL-HDF) may improve clinical outcomes. Currently, the world-wide acceptance of HDF is low because higher costs and its benefits have not been well demonstrated.
The aim of this prospective and controlled study was to compare the effects of post-dilution OL-HDF and conventional high-flux HD during one year.

Methods

One-hundred fifteen clinically stable HD patients were randomized in two groups: OL-HDF group (55 patients, ages 29-81 years, mean time on dialysis 5.2 years) and HD group (60 patients, ages 39-95 years, mean time on dialysis 6.5 years). All patients were scheduled sessions thrice weekly with a stable arteriovenous fistula, blood flow rate (QB) 364 ml/min (316-410 ml/min) in OL-HDF and QB 356 ml/min (306-400 ml/min) in HD. The same Polysulfone membrane high-flux dialysers and Artis Physio dialysis machines for both groups were used during the entire study period. OL-HDF procedure was performed in the post-dilution mode and the substitution volume was targeted to be above 20 L per session.

Results

During follow-up, there were no significant differences in mean hemoglobin (11.7±1.5 g/dl OL-HDF vs. 11.74±1.45 g/dl HD), mean transferrin saturation (24.6±14.3% OL-HDF vs. 22.9±16.4% HD), but the mean prescribed erythropoietin (EPO) dosage was significantly lower in OL-HDF than HD (14676±2889 vs. 15300±4550 U/month, P<0.05). The mean prescribed intravenous iron dosage was not different among the groups.
OL-HDF group was lower the mean ferritin (483.3±45.7 ng/mL vs. 601.6±35.6 ng/mL, P<0.005), mean high-sensitivity C-reactive protein (0.42±0.1 mg/dL vs. 0.62±0.15 mg/dL), mean intact parathyroid hormone (327.09±45.7 pg/mL vs. 346.95±35.6 pg/mL, P<0.05), despite similar calcium (8.82±0.14 mg/dL vs. 8.89±0.16 mg/dL) and phosphorus (4.09±0.16 mg/dL vs. 4.01±0.11 mg/dL, P>0.05).
The β-2 microglobulin remained lower (23.53±12.1 mU/mL vs. 26.94±12.43 mU/mL, P<0.05) and mean Kt was significantly higher (53.12±1.9 vs. 48.18±1.87, P< 0.05) in OL-HDF, despite the mean eKt/V was similar in both groups.

Conclusion

Post-dilution OL-HDF is a safe and well-tolerated treatment, increased dialysis dose, reduced inflammation and needed lower requirement for EPO to correct anemia compared with high-flux HD.