Hemodiafiltration Improves Low Levels of Health-Related Quality Of Life (Qol) and Nutritional Conditions of Hemodialysis Patients

Abstract

We compared the effects on the nutritional condition and health-related quality of life (HR-QoL) of the treatment of patients with on-line hemodiafiltration (OL-HDF) and conventional hemodialysis (CHD) using a superflux dialyzer. In total, 47 maintenance (M) HD patients were treated by CHD with a high-flux dialyzer for the first 4 months (1st CHD) and were then switched to predilution OL-HDF for the next 4 months (OL-HDF), after which CHD was resumed for the last 4 months (2nd CHD). We assessed the clinical parameters, fat mass value, muscle mass value, and HR-QoL. In patients with low serum albumin levels, these levels significantly (p < 0.05) increased in the OL-HDF period. Moreover, the fat mass values significantly (p < 0.05) increased in patients with decreased fat mass values in the OL-HDF period. Although there was no significant difference in the patients with higher scores of physical functioning, role physical, vitality, and social functioning, patients with lower scores in the 1st CHD period had significantly increased (p < 0.05) in the OL-HDF period. In this crossover study, we revealed that OL-HDF treatment significantly improved the nutritional conditions and HR-QoL scores compared with the improvement observed after CHD with a superflux dialyzer, especially for maintenance hemodialysis patients with malnutrition and a low QoL.

Convection volume, β2‐microglobulin and α1‐microglobulin reduction ratios, and body composition in pre‐dilution online haemodiafiltration

“…3 For the first time, Savica et al reported an increase in BMI and fat-free mass in patients who had switched from HD to Pre-OL-HDF for 6 months. 16 Several studies found improvement of nutrition and muscular volume in patients treated with Pre-OL-HDF compared with conventional HD, 16,17,18 but Shigematsu et al found no significant differences in muscle mass. 19 One study reported that the higher amino acid losses from the high-exchange volumes used in Pre-OL-HDF worsened body composition.…”

Systematic review to compare the outcomes associated with the modalities of expanded hemodialysis (HDx) versus high‐flux hemodialysis and/or hemodiafiltration (HDF) in patients with end‐stage kidney disease (ESKD)

“…46 A total of 11 RCTs reported clinical outcomes, 22,38,39,41,43,44,48,51,53,57 and two were cost-utility analyses of HDF versus HD. 47,50 Fifteen publications were cohort studies, [23][24][25][26][34][35][36][37]42,45,49,52,[54][55][56] of which two reported on HDx 37,54 and the remainder reported on HDF. One cross-sectional study was identified that compared HDF with high-flux HD.…”

“…Thirteen publications reported QoL and/or patient-reported outcomes. [35][36][37]41,43,44,[46][47][48]50,51,53,57 Of these, four compared HDF with high-flux HD, 41,44,53,57 with one reporting a statistically significant beneficial effect 44 and three reporting a numerical benefit 41,53,57 in favor of HDF. Three publications compared HDF with HD (flux level not reported) 35,43,47 with one reporting a statistically significant beneficial effect 43 and two a numerical benefit on QoL with HDF.…”

“…[35][36][37]41,43,44,[46][47][48]50,51,53,57 Of these, four compared HDF with high-flux HD, 41,44,53,57 with one reporting a statistically significant beneficial effect 44 and three reporting a numerical benefit 41,53,57 in favor of HDF. Three publications compared HDF with HD (flux level not reported) 35,43,47 with one reporting a statistically significant beneficial effect 43 and two a numerical benefit on QoL with HDF. 35,47 The QoL in patients undergoing HDF was compared with those undergoing low-flux HD in two studies with both reporting a numerical benefit of HDF on QoL measures.…”

“…Three publications compared HDF with HD (flux level not reported) 35,43,47 with one reporting a statistically significant beneficial effect 43 and two a numerical benefit on QoL with HDF. 35,47 The QoL in patients undergoing HDF was compared with those undergoing low-flux HD in two studies with both reporting a numerical benefit of HDF on QoL measures. 50,51 One study compared HDx with HDF and reported no difference in Dialysis Symptom Index between modalities.…”