Online hemodiafiltration: 4 years of clinical experience

Abstract

Online hemodiafiltration (online HDF) is a new hemodialysis technique combining convection and diffusion and thus also enabling the purification of large molecules. As yet, only a small number of clinical experiences have been published about the effectiveness and safety of online HDF. We present a prospective and observational study conducted on 31 patients treated with online HDF in our center in the last 4 years. The purpose of the study is to compare the evolution of the following aspects before and after starting online HDF: dose of dialysis, purification of medium-sized/large molecules, inflammation, nutrition, Ca-P metabolism, anemia, and intradialytic complications. Online HDF increased Kt/V to 31.0% (p > 0.001) and reduced postdialysis beta(2)-M to 66.4% (p > 0.001). The rest of the parameters analyzed did not vary significantly. During online HDF, episodes of symptomatic hypotension fell by 45% in relation to conventional hemodialysis, and no relevant complication occurred. Online HDF is very useful in patients in whom we need to increase replacement therapy, such as patients with a large body surface, those in whom we suspect a residual syndrome or those who have been receiving dialysis for a long time and for whom we wish to prevent amyloidosis. Online HDF is safe and better tolerated than conventional hemodialysis.

Long-Term Outcomes in Online Hemodiafiltration and High-Flux Hemodialysis

“…Previous studies demonstrated similar benefits (28,29), although such findings are not universal (30,31). It seems that a cooling effect of the infusate may play a major role (31,32).…”

Haemodiafiltration versus High-Flux Haemodialysis: Effects on Phosphate Control and Erythropoietin Response

“…In addition, haemodiafiltration has been reported to improve nutritional parameters and reduce micro-inflammation [19]. Both of which could potentially lead to increased erythropoietin responsiveness, with higher haematocrit and reduced erythropoietin dosages [11,12].…”

Haemodiafiltration Does Not Reduce the Frequency of Intradialytic Hypotensive Episodes when Compared to Cooled High-Flux Haemodialysis

“…In addition to increasing middle molecule clearances, convective treatments have also been reported to improve cardiovascular stability during treatment sessions [7] and reduce the frequency of intradialytic hypotension [8] both with haemofiltration and HDF [8,9]. Other centres have also reported an improvement in interdialytic blood pressure control following the introduction of HDF [10].…”