Haemodiafiltration Results in Similar Changes in Intracellular Water and Extracellular Water Compared to Cooled Haemodialysis

Abstract

Background/Aims: Intradialytic hypotension is the most common complication of modern day haemodialysis (HD). Convective modalities, including haemodiafiltration (HDF) are reported to result in greater cardiovascular stability compared to standard HD, which has been suggested to be due to improved solute transport between compartments. We therefore investigated the effect of treatment on body water by bioimpedance. Methods: We measured the change in extracellular water (ECW) and intracellular water (ICW) in 263 outpatients attending for HD using cooled dialysate and 134 patients for HDF. Results: Patient cohorts were matched for demographics, dialysate composition, ultrafiltration rate, and session duration. The fall in systolic blood pressure following HD was -11.8 mm Hg (-25.3 to 2.3) and not different from that following HDF -12 mm Hg (-27 to 6). Similarly there were no differences in pretreatment serum sodium and dialysate sodium gradient [HD 1 mmol/l (-1 to 3) vs. HDF 2 mmol/l (1 to 4)], or change in serum sodium posttreatment [HD 0 mmol/l (-2 to 2) vs. HDF 1 mmol/l (-1 to 3)]. There were no differences in ICW or ECW pretreatment, and following treatment the reduction in ICW and ECW did not differ [ICW HD -3.5% (-5.7 to -1.8) vs. -4.1% (-6.0 to -1.7), ECW HD -7.1% (-9.4 to -4.7) vs. HDF -7.1% (-9.7 to -4.9)]. Conclusion: We were unable to demonstrate any advantage for HDF over HD using cooled dialysate in terms of changes in blood pressure during a treatment session, or differences in the relative changes in ICW or ECW volumes.

The Effects of Comfort-Based Interventions (Back Massage and Patient and Family Education) on the Level of Comfort Among Hemodialysis Patients

“…Item scoring is done on a six-point Likert-type scale from 1 ("Strongly disagree") to 6 ("Strongly agree"). Items 2,4,7,11,13,14,15,18,19, and 22 -24 are scored reversely. The possible total scores of the physical, psychospiritual, social, and environmental dimensions and the total HCQ score are 5 -30, 10 -60, 4 -24, 5 -30, and 24 -144, respectively.…”

“…However, alongside with positive outcomes, it can cause different problems and complications (3,4). Physical dysfunction, nutritional alterations, fluid restriction, pain, attention deficit, dependence, employment loss, financial strains, frequent hospitalizations, and fear over death can negatively affect hemodialysis patients' lifestyle, health status, and comfort (5,6).…”

“…However, despite the great need of hemodialysis patients for comfort (33), hemodialysis-related nursing care measures are mainly focused on the fulfillment of their physical needs (4,7). Given the paucity of studies into the level of comfort among Iranian hemodialysis patients and the contradictory results of previous studies, this study was conducted to evaluate the effects of comfort-based interventions (back massage and patient and family education) on the level of comfort among hemodialysis patients.…”

Do Bioimpedance Measurements of Over-Hydration Accurately Reflect Post-Haemodialysis Weight Changes?

“…Previous studies on BIS have reported on Caucasoid and African-American HD patients [2,3,22], and we did have patients from other ethnic groups, and reports have suggested that some bioimpedance measurements may vary between ethnic groups, but not in terms of ECW status [23,24], and we also did not find any association with ethnicity.…”

Hemodiafiltration Does Not Have Additional Benefits over Hemodialysis on Arterial Stiffness, Wave Reflections and Central Aortic Pressures

“…cardiac-depressant toxins or ouabain-like substances) by combining diffusive and convective transport through hemodiafiltration [12]. However, this hypothesis was not confirmed in other studies showing that both hemodiafiltration and standard hemodialysis exert comparable effects on intradialytic BP [21,22,23] and on removal of circulating markers of endothelial dysfunction, subclinical vascular inflammation and oxidant stress [15,21]. In agreement with these findings, hemodiafiltration in the present study was associated, if anything, with numerically more pronounced reductions in central aortic pressures in parallel to a greater intradialytic weight loss than hemodialysis, suggesting that when net ultrafiltration volume is high it would be followed by more potent hemodynamic responses irrespective to the dialytic modality.…”