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Kidney Week

Abstract: FR-PO463

Haemodialysis (HD) vs. Online Haemodiafiltration (HDF) and Mixed Haemodiafiltration (MHDF): What Place?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Shivakumar, Kunigal A., Russells Hall Hospital, Dudley, United Kingdom
Background

HD has been a gold standard of dialysis. High-efficiency on-line HDF is recognised as an advanced modality of treatment improving patient outcome. Yet post-dilution HDF has limitations like increased blood viscosity, protein concentration, high transmembrane pressure impairing uraemic solute removal. Pre-dilution method can partially overcome this but the price to pay is decreased overall efficiency.Joining both modalities can potentially improve conductive and convective solute removal and maintain patients haemodynamic stability.

Methods

Eighteen ESRD adults established on HD for at least one year were chosen. They received 6 months conventional HD, followed by 6 months HDF (with 1.2 HDF factor), then 6 months MHDF. Fresenius 5008 machines were used with FXCorDiax1000 dialysers and therapy monitoring system (TMON). A central delivery system supplied 3 types of fluid and ultrapure water direct to the machines. All patients had cardiovascular instability. Various parameters were measured monthly as per standard UK Renal Association guidelines. SF24 Quality of Life questionnaire was analysed by an independent observer.

Results

Results are summarised in the table with mean values.
The increased urea reduction rate on HDF and MHDF over conventional HD was statistically significant, p=0.002 and 0.003 respectively. There was no difference between HDF v MHDF. Similarly the difference in Kt/V between HD v HDF and MHDF was significant, p=0.005 and 0.009 with no difference between HDF and MHDF.Differences in pre-dialysis phosphate level between the 3 modalities was not statistically significant although the post-therapy phosphate value between HD v HDF and MHDF showed a p value of 0.003.The haemoglobin and PTH had no significant differences between modalities. We measured β2 microglobulin and proBNP in the MHDF group, the diffence in 6 months was insignificant.HDF and MHDF patients had higher physical and mental component scores.

Conclusion

On-line HDF and MHDF are superior to conventional highflux dialysis, we could not observe additional benefit between HDF and MHDF. Perhaps using a higher HDF factor for dilution and substitution fluid is required to achieve better results.

 URR %Kt/VPhosphate (mmol/l)Haemoglobin (gm/l)PTH (pmol/l)
HD64±4.51.25±0.431.93±0.3510731.2±20.3
HDF71±2.51.53±0.401.67±0.4110425.1±19.4
MHDF68±3.61.41±0.361.90±0.3811024.1±16.4

Funding

  • Government Support - Non-U.S.