Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis

Donauer, Johannes; Schweiger, C.; Rumberger, Brigitta; Krumme, B.; Böhler, Joachim

doi:10.1093/ndt/gfg206

Cited by 126 publications

(101 citation statements)

References 17 publications

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“…This benefit of OL-HDF on intradialytic hypotension episodes has previously been described. 23,24 In addition, infection-associated mortality was also reduced by OL-HDF. ESRD patients have a significant risk of infectious complications, which represent the first cause of hospitalization and the second cause of death in hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

Maduell

Moreso

Pons³

et al. 2013

Journal of the American Society of Nephrology

617

619

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Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.

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Section: Discussionmentioning

confidence: 99%

High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

Maduell

Moreso

Pons³

et al. 2013

Journal of the American Society of Nephrology

617

619

View full text Add to dashboard Cite

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“…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). There has been some concern that using the same dialysis fluid sodium level in online HDF and HD may result in sodium loading in the HDF group.…”

Section: Discussionmentioning

confidence: 98%

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

Vilar

Fry

Wellsted

et al. 2009

Clinical Journal of the American Society of Nephrology

147

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“…Nevertheless, it has been reported that the cold effect is still present in online HDF. 27 Our idea was to reproduce as closely as possible what physicians do in everyday clinical practice when using different techniques, independent of the pathophysiologic interpretation of the ISH; therefore, we decided not to give the investigators strict guidelines as to how to perform the treatments, Figure 2. 7.5% of all of the 28,950 sessions were complicated by ISH.…”

Section: Discussionmentioning

confidence: 99%

Hemofiltration and Hemodiafiltration Reduce Intradialytic Hypotension in ESRD

Locatelli

Altieri

Andrulli

et al. 2010

Journal of the American Society of Nephrology

241

192

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Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. In this multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n ϭ 70), online predilution hemofiltration (HF; n ϭ 36), or online predilution hemodiafiltration (HDF; n ϭ 40). The primary end point was the frequency of intradialytic symptomatic hypotension (ISH). Compared with the run-in period, the frequency of sessions with ISH during the evaluation period increased for HD (7.1 to 7.9%) and decreased for both HF (9.8 to 8.0%) and HDF (10.6 to 5.2%) (P Ͻ 0.001). Mean predialysis systolic BP increased by 4.2 mmHg among those who were assigned to HDF compared with decreases of 0.6 and 1.8 mmHg among those who were assigned to HD and HF, respectively (P ϭ 0.038). Multivariate logistic regression demonstrated significant risk reductions in ISH for both HF (odds ratio 0.69; 95% confidence interval 0.51 to 0.92) and HDF (odds ratio 0.46, 95% confidence interval 0.33 to 0.63). There was a trend toward higher dropout for those who were assigned to HF (P ϭ 0.107). In conclusion, compared with conventional HD, convective therapies (HDF and HF) reduce ISH in long-term dialysis patients.

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Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis

Cited by 126 publications

References 17 publications

High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

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

Hemofiltration and Hemodiafiltration Reduce Intradialytic Hypotension in ESRD

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