Abstract: FR-PO0456
Clinical Impact of Online High-Volume Hemodiafiltration in Elderly Patients with ESRD: Evidence from a Large Observational Study in Brazil
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Author
- Silveira Junior, Sergio Antonio Dias Da, Prevent Senior Private Operadora de Saude Ltda, São Paulo, SP, Brazil
Background
Online high-volume hemodiafiltration (HDF) offers potential clinical advantages over conventional hemodialysis (HD), including improved hemodynamic tolerance and reduced inflammation. However, its real-world impact on clinical outcomes in elderly patients with end-stage renal disease (ESRD) remains underreported, particularly in middle-income countries.
Methods
We performed a retrospective cohort study of 2,167 elderly patients (mean age: 72.7 years) enrolled in a Brazilian private health plan from 2018 to 2023. Patients were classified into three groups: (1) HD-only, (2) exclusive HDF online, and (3) HD→HDF converters. Clinical outcomes included emergency visits, hospital admissions, outpatient consultations, high-complexity procedures, and all-cause mortality. Difference-in-differences models and Callaway & Sant’Anna estimators were used to assess causal effects. Cox regression was applied to evaluate mortality risk.
Results
Patients treated with HDF online experienced significant reductions in emergency visits (p < 0.001), outpatient consultations (p < 0.001), and high-complexity procedures (p < 0.01). Mortality hazard was reduced by 43% in the HDF group (HR: 0.574; 95% CI: 0.48–0.68; p < 0.001) and 39% in the HD→HDF converters (HR: 0.607; p < 0.001). No significant differences were observed in hospital admission rates.
Conclusion
Online HDF was associated with improved clinical outcomes and reduced mortality among elderly ESRD patients in a real-world private healthcare setting. These findings support the broader implementation of HDF, especially in aging dialysis populations.