Kidney Week

Abstract: SA-PO1112

Fifty Thousand Sessions Later: A Single Institution Experience with Short Daily Online Hemodiafiltration

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Pascoal, Istenio, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Istenio Pascoal, MD

• Melo, Natalia C.V., Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Natalia C.V. Melo, MD

• Lauar, Julia, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Julia Lauar, MD

• Costa, Tiago Emanuel, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Tiago Emanuel Costa, MD

• Pascoal, Felipe, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Felipe Pascoal, MD

• Pascoal, Pedro Guimaraes, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Pedro Guimaraes Pascoal, MD

• Pascoal, Mateus Guimarães, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Mateus Guimarães Pascoal, MD

• Simon, Adolfo, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Adolfo Simon, MD

• Bello, Vilber, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Vilber Bello, MD

• Xavier, Kelia, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Kelia Xavier, MD

• Lauar, Juliane, Centro Brasiliense de Nefrologia Ltda, Brasília, DF, Brazil

Juliane Lauar, MD

Background

Hemodiafiltration (HDF) has emerged as an effective modality for renal replacement therapy, demonstrating superior solute clearance compared to conventional hemodialysis. Short daily hemodiafiltration (SDHDF) may further enhance HDF performance and improve clinical outcomes. This study evaluates the implementation and results of the first 50,000 SDHDF treatments conducted at a single institution.

Methods

This retrospective cohort study spanned 30 months (November 2023 to April 2026) across three dialysis centers within a single institution, involving 102 patients (65% male) undergoing SDHDF (5-7 sessions per week, each lasting 2 hours). Patients receiving treatment for less than three months were excluded. Data were collected on demographics, comorbidities, vascular access profile, bioimpedance-measured fluid status, hospitalization rates, and mortality. Statistical analyses included ANOVA, Kruskal-Wallis test, chi-square test, Fisher's exact test, and Kaplan-Meier survival analysis (p < 0.05).

Results

At enrollment, the mean patient age was 66.2±12.1 years. Comorbidities included diabetes mellitus (40%), hypertension (26%) and coronary artery disease and/or heart failure (60%). Vascular access distribution was as follows: arteriovenous fistula (AVF) 59.8%, arteriovenous graft (AVG) 14.7%, and central venous catheter (CVC) 25.5%. The target blood flow rate was 380 mL/min; the mean achieved rate was lower with CVC (367±14 mL/min) compared to AVF and AVG (372±11 and 372±12 mL/min; p = 0.03). The mean weekly post-dilutional convective volume was comparable across access types (AVF: 66.5±9.8 L; AVG: 65.5±8.7 L; CVC: 63.8±7.3 L). Notably, 71.5% of patients achieved >63 L/week convective volume, while 37.2% exceeded >69 L/week. The overall pre-HDF fluid overload was 1.2±0.9 L, with 33% of patients with fluid overload, 57% normally hydrated, and 10% fluid depleted. The hospitalization rate was 0.29 admissions per patient-year, and 13 deaths occurred during follow-up, resulting in an annual mortality rate of 5.1%.

Conclusion

The promising outcomes associated with short daily hemodiafiltration highlight its potential as a transformative approach in renal therapy. By continuing to explore its benefits, optimizing treatment protocols, and addressing the barriers to its adoption, the healthcare community can significantly improve patient outcomes.

Funding

• Private Foundation Support