Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly

Abstract

Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30-day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux hemodialysis and online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a statistical unit according to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of metabolic bone disease biomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux hemodialysis in the elderly.

Comparison of Solute Clearance, Hospitalization Rate, and Aortic Arch Calcification between Online Hemodiafiltration and High-Flux Hemodialysis: A 6-Year Observational Study

“…Several studies have addressed the advantage of HDF compared with standard HD. The CONvective TRAnsport STudy (CONTRAST) and French Convective versus Hemodialysis in Elderly (FRENCHIE) studies showed the effect of pre-dialysis serum phosphate reduction by HDF therapy [6, 7]. Other studies also demonstrated that HDF therapy is superior compared to standard HD in reducing inflammation [8, 9], preventing protein-energy wasting [10], and reducing episodes of intradialytic hypotension [11].…”

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

“…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).…”

Cardiovascular Risk Factors in End-Stage Renal Disease Patients: The Impact of Conventional Dialysis versus Online-Hemodiafiltration

“…A significantly lower occurrence of adverse events, with fewer episodes of intradialytic symptomatic hypotension and muscle cramps, was found for OL-HDF patients; moreover, serum albumin values were similar, but an improvement in metabolic bone disease biomarkers and in β 2 -microglobulin levels was found [100]. HRQoL, morbidity and mortality were similar for both treatments.…”

“…The French Convective versus Hemodialysis in Elderly (FRENCHIE) study aimed to compare intradialytic tolerance of OL-HDF versus high-flux HD [100]. A significantly lower occurrence of adverse events, with fewer episodes of intradialytic symptomatic hypotension and muscle cramps, was found for OL-HDF patients; moreover, serum albumin values were similar, but an improvement in metabolic bone disease biomarkers and in β 2 -microglobulin levels was found [100].…”