Effects of online hemodiafiltration on anemia and nutritional status in chronic hemodialysis patients

Abstract

Background: Online hemodiafiltration (OL-HDF) offers considerable advantages in clearance of molecules of various sizes. However, evidence of clinical effects of OL-HDF is scarce in Korea. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF. Methods: Adult patients with end-stage renal disease undergoing hemodialysis (HD) were prospectively enrolled in a K-cohort (CRIS no. KCT0003281) from 6 tertiary hospitals in South Korea. We recruited 435 patients, 339 of whom were on HD at enrollment. One hundred eighty-two patients were followed for more than 24 months. Among them, 44 were switched to OL-HDF for more than 12 months without conversion to HD. We used a paired t test to compare baseline and 24-month follow-up results. Results: The mean age of the subjects was 61.2 ± 12.2 years, and 62.6% were male. The baseline hemoglobin level was not significantly different between HD and OL-HDF group (10.61 ± 1.15 vs. 10.46 ± 1.03 g/dL, P = 0.437). However, the baseline serum protein and albumin levels were significantly lower in the OL-HDF group (6.82 ± 0.49 vs. 6.59 ± 0.48 g/dL, P = 0.006; 3.93 ± 0.28 vs. 3.73 ± 0.29 g/dL, P < 0.001). In patients switched to OL-HDF, levels of hemoglobin and serum albumin significantly increased (10.46 ± 1.03 vs. 11.08 ± 0.82 g/dL, P = 0.001; 3.73 ± 0.29 vs.

Effect of Dialysis Modality on Bone Disease in Patient with End Stage Renal Disease

“…In this work we didn't find any difference between both groups as regard blood hemoglobin levels. This is against Lee et al (13) , who showed significant improvement in blood hemoglobin level in online HDF group compared to high flux HD, which may be attributed to longer duration (24 months) and larger sample size.…”

Cardiovascular Risk Comparison between Expanded Hemodialysis Using Theranova and Online Hemodiafiltration (CARTOON): A Multicenter Randomized Controlled Trial

“…Post hoc and pooled analyses suggest that a high convection volume may be needed to show better outcomes in online-HDF than in conventional HD 22 , 23 , 25 . European regulatory authorities have allowed online-HDF to be used in patients with uncontrolled hyperphosphatemia and those suffering from complications such as amyloidosis 21 , 42 , but this issue may not be similarly accepted in other countries because of limitations in setting up online-HDF. Before conducting online-HDF, new machines, quality control in substituting fluids, and trained staff are needed, all of which limit its utilization, particularly in primary clinics or developing countries 43 .…”

Mixed- versus predilution hemodiafiltration effects on convection volume and small and middle molecule clearance in hemodialysis patients: a prospective randomized controlled trial

“…Albumin loss via HDF can differ depending on the dialyzer, dialysis modalities, and convection volumes. Previous studies have reported a wide range of albumin loss between 0.5 and 4.5 g per session in postdilution HDF [34][35][36]. The amount of albumin loss in mixed-HDF is not well known.…”