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Kidney Week

Abstract: FR-PO460

A Comparative Analysis of Clinical Outcomes in Hemodiafiltration and High Flux Hemodialysis: A Retrospective Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Sunga, Yoradyl Dalupang, St. Lukes Medical Center, quezon City, Philippines
Background

Conventional Hemodialysis is the most common treatment modality of renal replacement therapy. It clears uremic toxin by diffusion with insufficient removal of middle sized molecules. Online hemodiafiltration was introduced to increase its clearance.

olHDF is considered to have more clinical benefits due to its combined diffusive and convective mechanism. It has better clearance of phosphate, improves erythropoietin response, better intradialytic hemodynamic stability and quality of life.

Primary objective was to compare the effectiveness of HDF and HFHD among ESRD patients on maintenance hemodialysis at SLMC-Global City and SLMC-QC in terms of survival rate, dosage requirement of Erythropoietin Stimulating Agent, rate of patients who achieved the target hemoglobin, phosphorus and Kt/V. Secondary outcome determined the substitution volume that provides survival benefits among patients on online hemodiafiltration.

Methods

This is a retrospective cohort study of all adult patients who underwent two to three sessions a week of high flux HD and hemodiafiltration.The study population included all ESRD patients aged 19 and above, on maintenance dialysis for more than or equal to 3 months on January 2015- March 2017. Online hemodiafiltration at SLMC-Global City uses auto-substitution volume for each treatment session.

Results

A total of 171 patients were included. 83 patients on HDF and 88 patients on HFHD group. There is a higher survival rate for patients on HDF at 1st and 2ndyear of dialysis 93.97 and 92.77% respectively. No significant difference in dosage requirement of ESA, rate of patients who achieved target hemoglobin, phosphorus level and kt/V at 3rd, 6thand 12th month. Substitution volume of 15-19 Liters has higher survival rate that those with 20-25 liters. For every unit increase in substitution volume at 12 months, the odds of mortality decreases by 21.46%.

Conclusion

The result showed that there is higher survival rate for patients on HDF than on HFHD, no significant difference on requirement of ESA dose, achieving target phosphorus, hemoglobin and dialysis adequacy between the two modality. There is a trend of survival benefit and improvement in Kt/V for patients with higher substitution volume.
We recommend caution in interpretation of these retrospective data. A randomized clinical trials is still needed to validate findings.