Convection with conviction–online hemodiafiltration for all: Single center clinical observations

Abstract

Online hemodiafiltration (HDF) has recently become an alternative to conventional hemodialysis for treatment of end-stage renal disease with superior results. Clinical experience with HDF in unselected populations has not been widely published and a longitudinal study on such a group of patients is presented here.

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

“…Theories were developed as to whether this was due to the removal of cardiac depressant toxins, and ouabain-like substances [7,20]. Although several groups have also reported fewer intra-treatment hypotensive episodes during HDF [8,10,18,22,23], we were unable to confirm these findings. In our study, there was no consistent pattern in the fall in systolic or mean arterial blood pressure during a treatment session.…”

“…Other centres have also reported an improvement in interdialytic blood pressure control following the introduction of HDF [10]. However, other studies have failed to confirm these findings [11], and it has been suggested that any benefit reported may have been due to additional thermal cooling associated with HDF [12].…”

“…In addition, HDF has been reported to improve cardiovascular stability during treatment sessions, with less intra-treatment hypotension [7,8,22,23], as well as improve blood pressure control [10]. …”

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

“…This was attributed to the higher convection volumes, although there were also significant differences in urea clearance. We have not demonstrated a nutritional benefit of HDF over high-flux HD, as suggested by others (29), although our analysis was confined to a comparison of serum albumin levels and BMI; however, our data do suggest a beneficial effect of HDF on inflammatory status, CRP being generally lower in the HDF group, significantly at two time points.…”

“…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).…”