Comparison of clinical outcomes of conventional hemodialysis and online hemodiafiltration

M. Sohail Malik; Mohammed Fahad Khan; Kishore Babu; Vishwanath Siddini; Sudarshan Ballal

doi:10.18203/2320-6012.ijrms20232426

Authors

M. Sohail Malik Department of Nephrology, Manipal Hospitals, Bangalore, Karnataka, India
Mohammed Fahad Khan Department of Nephrology, Manipal Hospitals, Bangalore, Karnataka, India
Kishore Babu Department of Nephrology, Manipal Hospitals, Bangalore, Karnataka, India
Vishwanath Siddini Department of Nephrology, Manipal Hospitals, Bangalore, Karnataka, India
Sudarshan Ballal Department of Nephrology, Manipal Hospitals, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232426

Keywords:

Hemodiafiltration, Hemodialysis, Online, Outcome

Abstract

Background: Several studies have suggested that online hemodiafiltration (OL-HDF) may reduce the risk of mortality and improve quality of life of these patients compared with standard hemodialysis.

Methods: Forty stable out patients on dialysis (20 patients on hemodialysis and 20 patients on online hemodiafiltration) above age of 18 years and dialysis vintage of more than 3 months were followed up for 18 months. Clinical, biochemical parameters of these patients along with the SF-36 score at baseline and after 18 months of follow up were assessed.

Results: At 18 months, statistically significant difference was found between hemodialysis (HD) and OL- HDF groups in erythropoietin dose (p=0.047), urea reduction ratio (p=0.016), Kt/V (p=0.005), hemoglobin (p=0.043), serum albumin (p=0.002), phosphorus (p=0.024), parathyroid hormone (p=0.007), potassium (p=0.007), β₂ microglobulin (p=0.002), high sensitive c-reactive protein (p=0.037), and serum bicarbonate levels (p=0.022). We found statistically significant difference in intradialytic complications namely intradialytic hypotension, muscle cramps, simultaneous hypotension and muscle cramps and stoppage of dialysis. In terms of mortality, the difference was not statistically significant (p=0.052).

Conclusions: Patients on OL- HDF were having better quality of life than patients on HD. Better solute clearance, anemia control, improved nutritional and Mineral bone disorder parameters were seen in OL-HDF. Less complications during dialysis were seen with OL-HDF. The difference in mortality rate between the HD group and OL- HDF group was not statistically significant.

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References

Collins AJ, Foley RN, Herzog C, Chavers BM, Gilbertson D, Ishani A, et al. Excerpts from the US renal data system 2009 annual data report. Am J Kidney Dis. 2010;55(1):A6-7.

Canaud B, Bosc JY, Leray H, Stec F, Argiles A, Leblanc M, et al. On-line haemodiafiltration: state of the art. Nephrol dialys transplant. 1998;13(suppl_5):3-11.

Constitution of the World Health Organization. In: World Health Organization. Handbook of basic documents. 5th edn. Geneva: Palais des Nations; 1952:3-20.

Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med. 1996;334(13):835-40.

Khan IH, Garratt AM, Kumar A, Cody DJ, Catto GR, Edward N, et al. Patients’ perception of health on renal replacement therapy: evaluation using a new instrument. Nephrol Dialys Transplant. 1995;10(5):684-9.

Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51(11):1055-68.

Gorodetskaya I, Zenios S, Mcculloch CE, Bostrom A. Health-related quality of life and estimates of utility in chronic kidney disease. Kidney Int. 2005;68(6):2801-8.

Pedrini LA, De Cristofaro V, Comelli M, Casino FG. Long-term effects of highefficiency on-line haemodiafiltration on uraemic toxicity. A multicentre prospective randomized study. Nephrol Dialys Transplant. 2011;26(8):2617-24.

Ok E, Asci G, Sevinc-Ok E, Kircelli F, Yilmaz M. Comparison of postdilution online hemodiafiltration and hemodialysis (Turkish HDF Study). NDT Plus. 2011;4(suppl 2):4.

Morena M, Jaussent A, Chalabi L, Leray-Moragues H. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int. 2017;91(6):1495-509.

Kantartzi K, Panagoutsos S, Mourvati E, Roumeliotis A, Leivaditis K, Devetzis V, et al. Can dialysis modality influence quality of life in chronic hemodialysis patients? Low-flux hemodialysis versus high-flux hemodiafiltration: a cross-over study. Ren Fail. 2013;35(2):216-21.

Mazairac AH, de Wit GA, Grooteman MP, Penne EL, van der Weerd NC, den Hoedt CH, et al. Effect of hemodiafiltration on quality of life over time. Clin J Am Soc Nephrol. 2013;8(1):82.

Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, et al. Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol. 2010;21(10):1798.

Ok E, Asci G, Sevinc-Ok E, Kircelli F, Yilmaz M. Comparison of postdilution online hemodiafiltration and hemodialysis (Turkish HDF Study). NDT Plus. 2011;4(2):4.

Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AH, et al. Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol. 2012;23(6):1087.

Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, et al. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soci Nephrol. 2013;24(3):487.

den Hoedt CH, Grooteman MP, Bots ML, Blankestijn PJ, van der Tweel I, van der Weerd NC, et al. The effect of online hemodiafiltration on infections: results from the CONvective TRAnsport STudy. PLoS One. 2015;10(8):e0135908.