Clinical Evidence on Hemodiafiltration: A Systematic Review and a Meta‐analysis

Mostovaya, Ira M.; Blankestijn, Peter J.; Bots, Michiel L.; Covic, Adrian; Davenport, Andrew; Grooteman, Muriël P.C.; Hegbrant, Jörgen; Locatelli, Francesco; Vanholder, Raymond; Nubé, Menso J.

doi:10.1111/sdi.12200

Cited by 123 publications

(117 citation statements)

References 24 publications

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“…The Turkish HDF and CONTRAST studies found no difference in mortality or cardiovascular events [15,16] whereas the ESHOL study reported a large (30%) reduction in all-cause mortality [17]. This evidence base is further complicated by the divergent results of four meta-analyses, all of which showed reductions in IDH with HDF but only one suggested improved patient outcomes [11][12][13][14]. A more recent pooled individual participant data analysis suggested a survival benefit with HDF, particularly with higher convection volumes [18].…”

Section: Discussionmentioning

confidence: 75%

“…To date, these findings have largely been generated using echocardiography to assess regional myocardial contractility [7,8], alongside two small studies using positron emission tomography (PET) to measure myocardial perfusion during HD [9,10]. On-line haemodiafiltration (HDF) is a modified haemodialysis (HD) modality incorporating increased convective clearance, which has long been reported to reduce intradialytic hypotension (IDH) [11][12][13][14]. However, despite three randomised controlled trials and several meta-analyses, opinion remains conflicted as to whether HDF improves patient outcomes and the mechanisms by which HDF may do so are not well elucidated [11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

130

118

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Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32–72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, and myocardial perfusion. Patients had mean±SEM ultrafiltration rates of 3.8±2.9 ml/kg per hour during HD and 4.4±2.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Buchanan

Mohammed

Cox

et al. 2016

JASN

130

118

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“…Mostovaya et al [69] compared exclusively HDF to HD (low-and high-flux) including 2402 patients. The meta-analysis identified six RCTs.…”

Section: Meta-analysesmentioning

confidence: 99%

Update on Clinical Evidence Supporting Hemodiafiltration

Canaud¹,

Grassmann²,

Scatizzi³

et al. 2016

Advances in Hemodiafiltration

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The aim of this chapter is to define hemodiafiltration target efficiency, to clarify the concept of "optimal convective dose," and to facilitate hemodiafiltration (HDF) implementation in clinical practice by addressing the need for the establishment of best clinical practices for HDF. The approach taken was to conduct a comprehensive summary of clinical evidence supporting HDF. Convective dose is the total ultrafiltered volume and is complementary to diffusive dose (urea Kt/V) as a dose-dependent parameter. It can be quantified and adjusted to patient characteristics. Factors affecting convective dose are discussed: patient characteristics, prescription-dependent factors, and technical and machine-dependent factors. The key issue of HDF prescription and implementation of best practices is addressed as are intermediary and endpoint clinical outcomes. The main messages are as follows: (1) HDF is safe and effective provided that best clinical practices are followed and the right convective dose is delivered; (2) HDF is easy to perform with new technology; and (3) depending on the convection volume, HDF reduces all-cause and cardiovascular mortality. Open challenges remain, namely, the implementation of best practices to (a) achieve optimal convection volume, (b) define patient subsets that would benefit more from HDF, and (c) evaluate new tools that fine-tune HDF prescription according to individual patient needs.

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“…On the other hand, some studies suggested that high-flux filters cannot be practically used at all dialysis sessions for all patients because these filters are not often economically affordable. The patients cannot also tolerate these filters for long periods (14). Munshi et al showed that high-flux dialysis increases the risk of hemodynamic instability and disequilibrium syndrome although high-flux filters accelerate urea clearance more than low-flux filters at a zero ultrafiltration rate and blood flow and low dialysate flow rate (15).…”

Section: Introductionmentioning

confidence: 99%

Comparison of two interventions of increased blood flow rate and high-flux filters on hemodialysis adequacy and complications; a quasi-experimental study

Shahdadi¹,

Balouchi²,

Haghighi³

2017

J Renal Inj Prev

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Dialysis should be a safe procedure with less complications. It should improve physical state of the patients. High dialysis adequacy should also be taken into account in dialysis procedure. Thereby, the present study recommended dialysis with increased blood flow rate with higher adequacy and less complications compared to routine dialysis despite insignificant difference in dialysis adequacy and complications between increased blood flow intervention and high-flux hemodialysis. Nevertheless, increased blood flow intervention increased dialysis adequacy. For this purpose, this intervention was preferred over high-flux hemodialysis. Introduction: Various parameters such as increased blood flow and high flux filter increase dialysis adequacy. Each parameter is associated with specific complications. Objective: The aim of this study was comparison of two interventions of increased blood flow rate and high-flux filter on hemodialysis adequacy and complications. Please cite this paper as: Patients and Methods:This was a single-group quasi-experimental before-and-after intervention study. Twenty-two patients undergoing dialysis three times a week in the last 6 months consented to participate in the study. The participants were selected using random sampling method. They were reevaluated prior to dialysis and every 30 minutes until the end of each hemodialysis session using dialysis complication checklist. Dialysis adequacy was measured at the end of the fourth session for each patient. Results: The paired t test results showed a significant increase in dialysis adequacy in dialysis with increased blood flow and dialysis with high flux filter (high-flux hemodialysis) compared to routine dialysis (P = 0.01). A significant increase was found in incidence of muscular cramp in dialysis with increased blood flow compared to routine dialysis based on McNemar's statistical test (P = 0.02). Conclusion: Dialysis adequacy improved in both increased blood flow intervention and highflux hemodialysis compared to routine dialysis. On the other hand, increased blood flow intervention was associated with less complications than high-flux hemodialysis. In addition, increased blood flow intervention was more efficient and safer than high-flux hemodialysis.

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Clinical Evidence on Hemodiafiltration: A Systematic Review and a Meta‐analysis

Cited by 123 publications

References 24 publications

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Intradialytic Cardiac Magnetic Resonance Imaging to Assess Cardiovascular Responses in a Short-Term Trial of Hemodiafiltration and Hemodialysis

Update on Clinical Evidence Supporting Hemodiafiltration

Comparison of two interventions of increased blood flow rate and high-flux filters on hemodialysis adequacy and complications; a quasi-experimental study

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