A Comparison of On-Line Hemodiafiltration and High-Flux Hemodialysis

Abstract

Abstract. Some of the morbidity associated with chronic hemodialysis is thought to result from retention of large molecular weight solutes that are poorly removed by diffusion in conventional hemodialysis. Hemodiafiltration combines convective and diffusive solute removal in a single therapy. The hypothesis that hemodiafiltration provides better solute removal than high-flux hemodialysis was tested in a prospective, randomized clinical trial. Patients were randomized to either on-line postdilution hemodiafiltration or high-flux hemodialysis. The groups did not differ in body size, treatment time, blood flow rate, or net fluid removal. The filtration volume in hemodiafiltration was 21 ± 1 L. Therapy prescriptions were unchanged for a 12-mo study period. Removal of both small (urea and creatinine) and large (β2-microglobulin and complement factor D) solutes was significantly greater for hemodiafiltration than for high-flux hemodialysis. The increased urea and creatinine removal did not result in lower pretreatment serum concentrations in the hemodiafiltration group. Pretreatment plasma β2-microglobulin concentrations decreased with time (P < 0 0.001); however, the decrease was similar for both therapies (P = 0.317). Pretreatment plasma complement factor D concentrations also decreased with time (P < 0.001), and the decrease was significantly greater with hemodiafiltration than with high-flux hemodialysis (P = 0.010). The conclusion is that on-line hemodiafiltration provides superior solute removal to high-flux hemodialysis over a wide molecular weight range. The improved removal may not result in lower pretreatment plasma concentrations, however, possibly because of limitations in mass transfer rates within the body.

Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment

“…In both the Turkish OL-HDF and FRENCHIE studies, no difference in the overall hospitalization rate was observed between the two groups (Supplement 9 forest plot 1.2), but in the ESHOL Study, the hospitalization rate was lower in the high-flow online HDF group (RR, 0.78; 95% CI, 0.67-0.90; p = 0.001). In terms of quality of life, our meta-analysis of six prospective clinical trials (excluding observational studies) [68][69][70][71][72][73] found no significant difference between the online HDF and HD groups.…”

Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment

“…In both the Turkish OL-HDF and FRENCHIE studies, no differences in overall hospitalization rates were observed between the two groups, but in the ESHOL study, the hospitalization rate was lower in the high-flow online HDF group (RR, 0.78; 95% CI, 0.67 to 0.90; p < 0.01). In terms of quality of life, a meta-analysis performed on six prospective clinical trials, excluding observational studies [ 58 – 63 ], found no significant difference between the online HDF and HD groups.…”

General Approach to Patients Admitted to The Emergency Department with Poisoning

“…Hemofiltration and hemodiafiltration can be applied for toxins that can be applied hemodialysis. Unlike hemodialysis, it is also effective in toxins with higher 8,12,13 . Due to the increasing technical need and transportation difficulties, its use in poisoning cases is limited 8,14 .…”