Convective Versus Diffusive Dialysis Therapies for Chronic Kidney Failure: An Updated Systematic Review of Randomized Controlled Trials

Nistor, Ionuţ; Palmer, Suetonia C.; Craig, Jonathan C.; Saglimbene, Valeria; Vecchio, Mariacristina; Covic, Adrian; Strippoli, Giovanni F.M.

doi:10.1053/j.ajkd.2013.12.004

Cited by 108 publications

(78 citation statements)

References 48 publications

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“…The Turkish HDF and CONTRAST studies found no difference in mortality or cardiovascular events [15,16] whereas the ESHOL study reported a large (30%) reduction in all-cause mortality [17]. This evidence base is further complicated by the divergent results of four meta-analyses, all of which showed reductions in IDH with HDF but only one suggested improved patient outcomes [11][12][13][14]. A more recent pooled individual participant data analysis suggested a survival benefit with HDF, particularly with higher convection volumes [18].…”

Section: Discussionmentioning

confidence: 99%

“…To date, these findings have largely been generated using echocardiography to assess regional myocardial contractility [7,8], alongside two small studies using positron emission tomography (PET) to measure myocardial perfusion during HD [9,10]. On-line haemodiafiltration (HDF) is a modified haemodialysis (HD) modality incorporating increased convective clearance, which has long been reported to reduce intradialytic hypotension (IDH) [11][12][13][14]. However, despite three randomised controlled trials and several meta-analyses, opinion remains conflicted as to whether HDF improves patient outcomes and the mechanisms by which HDF may do so are not well elucidated [11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

124

116

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Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32–72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, and myocardial perfusion. Patients had mean±SEM ultrafiltration rates of 3.8±2.9 ml/kg per hour during HD and 4.4±2.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

124

116

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“…Nistor et al [70,71] from the Cochrane group updated the previous systematic review of 2005 and compared HD (low-and high-flux) to convective-based modalities (HF, AFB, bag HDF, and online HDF) without considering convection volume. Thirty-five trials (4039 patients) were included in this meta-analysis and the effects on mortality were estimated.…”

Section: Meta-analysesmentioning

confidence: 99%

Update on Clinical Evidence Supporting Hemodiafiltration

Canaud¹,

Grassmann²,

Scatizzi³

et al. 2016

Advances in Hemodiafiltration

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The aim of this chapter is to define hemodiafiltration target efficiency, to clarify the concept of "optimal convective dose," and to facilitate hemodiafiltration (HDF) implementation in clinical practice by addressing the need for the establishment of best clinical practices for HDF. The approach taken was to conduct a comprehensive summary of clinical evidence supporting HDF. Convective dose is the total ultrafiltered volume and is complementary to diffusive dose (urea Kt/V) as a dose-dependent parameter. It can be quantified and adjusted to patient characteristics. Factors affecting convective dose are discussed: patient characteristics, prescription-dependent factors, and technical and machine-dependent factors. The key issue of HDF prescription and implementation of best practices is addressed as are intermediary and endpoint clinical outcomes. The main messages are as follows: (1) HDF is safe and effective provided that best clinical practices are followed and the right convective dose is delivered; (2) HDF is easy to perform with new technology; and (3) depending on the convection volume, HDF reduces all-cause and cardiovascular mortality. Open challenges remain, namely, the implementation of best practices to (a) achieve optimal convection volume, (b) define patient subsets that would benefit more from HDF, and (c) evaluate new tools that fine-tune HDF prescription according to individual patient needs.

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“…Low-flux HD provides, through diffusion, effective clearance of low-molecular weight solutes, such as urea and creatinine, but much less or negligible clearance of middle- and high-weight substances. As elevated levels of middle-weight molecules (i.e., β2-microglobulin) in HD patients were associated with increased mortality in observational studies, it was hypothesized that better clearance of such solutes through high-flux HD, hemodiafiltration (HDF), and particularly online-HDF, which can add high convective volumes, would be associated with decreased cardiovascular events and mortality [2]. …”

mentioning

confidence: 99%

Online Hemodiafiltration Improves Outcomes in Incident Patients with End-Stage Renal Disease: Another Brick in the Wall?

Sarafidis

2017

Am J Nephrol

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Convective Versus Diffusive Dialysis Therapies for Chronic Kidney Failure: An Updated Systematic Review of Randomized Controlled Trials

Cited by 108 publications

References 48 publications

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Update on Clinical Evidence Supporting Hemodiafiltration

Online Hemodiafiltration Improves Outcomes in Incident Patients with End-Stage Renal Disease: Another Brick in the Wall?

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