Effect of Hemodiafiltration Versus Hemodialysis on Cognitive Function Among Patients With End-Stage Renal Disease: A Multicenter Study

Abstract

Background: Cognitive impairment (CI) and dementia are common in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Their cause is multifactorial. Our study is first to compare the impact of hemodialysis (HD) and online hemodiafiltration (HDF) on patients’ cognitive outcomes. Methods: This was a cross sectional, multicenter cohort study. Adult ESRD patients aged >18 years on regular high flux HD or online HDF were recruited in the study. Clinical, laboratory, daily activities and cognitive functions assessment were assessed in all the involved individuals. Results: A total of 241 patients were successfully recruited into the study: 164 treated with high flux HD and 77 treated with HDF. Hypertension and diabetes were the commonest associated comorbidities. 85.9% of patients were functionally independent with no significant difference between those on HD versus HDF. 81.3% of our patients showed different degrees of CI. HDF has no superiority in the improvement of cognitive functions. Age, vitamin D level and haemoglobin (Hb) were the most independent predictors of cognitive function impairment among HD patients. Conclusions: Cognitive function impairment is a common problem in hemodialysis and is associated with multiple risk factors. HDF showed no beneficial effect over HD. There is no superiority of online HDF versus high flux HD in improving cognitive functions.

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

“…These include improvements in the social, physical, and professional domains, characterized by reduced fatigue, joint pain, stiffness, cramp frequency, pruritus, and episodes of hypotension [ 153 , 154 ]. However, current evidence does not support the significant improvement in cognitive function or in the physical and mental health domains with HDF [ 151 , 155 ]. The HDFit trial showed a mild improvement in physical activity, as reflected by higher step counts in patients treated with HDF [ 152 ].…”

Clinical performance, intermediate and long‐term outcomes of high‐volume hemodiafiltration in patients with kidney failure

“…15 The actual body of evidence fails to demonstrate a real improvement in cognitive function or physical or mental fitness when comparing OL-HDF versus HD. 47 However, these findings may strongly depend on the length of follow-up, as significant improvement in the various HRQoL aspects might not be achieved in short periods. The few studies that have assessed postdialysis fatigue and recovery time from dialysis treatment did not report a significant association between dialysis modalities and prevalence or severity of fatigue 48,49 or differences in recovery time.…”

“…The actual body of evidence fails to demonstrate a real improvement in cognitive function or physical or mental fitness when comparing OL‐HDF versus HD 47 . However, these findings may strongly depend on the length of follow‐up, as significant improvement in the various HRQoL aspects might not be achieved in short periods.…”