Does hemodiafiltration reduce vascular stiffness measured by aortic pulse wave velocity compared with high‐flux hemodialysis?

Charitaki, Evangelia; Davenport, Andrew

doi:10.1111/hdi.12119

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…The relevant factors include dysregulation of Ca and phosphate, hyperparathyroidism, underlying comorbid diseases, dialysis vintage, and age [31]. HDF has been reported in one cross-sectional study exhibiting no given benefits in terms of vascular stiffness compared to HD [32]. Moreover, HDF has also been demonstrated to have no benefits compared to HFHD with respect to mineral metabolism and blood pressure control in one retrospective study with a large sample size [33].…”

Section: Discussionmentioning

confidence: 99%

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

Hao

Yang

et al. 2019

Kidney Blood Press Res

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Background/Aims: Studies on the long-term clinical benefits of hemodiafiltration (HDF) and high-flux hemodialysis (HFHD) are very limited. This study aimed to investigate the hospitalization rate and aortic arch calcification (AAC) of these two dialysis modalities over 6 years. Methods: Participants who received regular HDF and HFHD in one hospital-facilitated hemodialysis center were prospectively enrolled after matching for age, sex, and diabetes between January 2009 and December 2014. Medical records were reviewed retrospectively on demographics, laboratory variables, calcified scores in aortic arch measured by chest radiography, and rates of hospital admission. Cox proportional hazard regression and linear regression were used to obtain the outcome results. Results: The HDF and HFHD groups consisted of 108 and 102 participants, respectively. Levels of laboratory variables including small soluble solutes and Kt/V were not statistically different over the 6-year period between the HDF and HFHD groups. Calcified scores of the aortic arch increased over 6 years in both groups. The changes in the mean calcified scores were significant when compared between the two groups (0.44–1.82 in HFHD, 0.79–1.8 in HDF, respectively, p = 0.008). Hospitalization rates were 735 per 1,000 patients in the HDF group and 852 per 1,000 patients in the HFHD group, respectively. No significant difference was observed in frequency and days of hospitalization between HDF and HFHD. Conclusion: Hospitalization rates and AAC were observed to be equal for HDF and HFHD.

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Section: Discussionmentioning

confidence: 99%

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

Hao

Yang

et al. 2019

Kidney Blood Press Res

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“…A beneficial effect of hemodiafiltration on arterial stiffness is supported by another observational study, in which aortic PWV measurements were performed 6 months apart in three different groups of ESRD patients [38]. The first group consisted of 69 ESRD patients receiving conventional low-flux hemodialysis, the second group consisted of 78 ESRD patients who were switched from low-flux hemodialysis to on-line hemodiafiltration, and the third group included 142 ESRD patients receiving long-term renal replacement therapy with on-line hemodiafiltration.…”

Section: Long-term Effects Of Hemodiafiltration On Arterial Stiffnessmentioning

confidence: 85%

“…The first group consisted of 69 ESRD patients receiving conventional low-flux hemodialysis, the second group consisted of 78 ESRD patients who were switched from low-flux hemodialysis to on-line hemodiafiltration, and the third group included 142 ESRD patients receiving long-term renal replacement therapy with on-line hemodiafiltration. Over the 6-month observational period, a significant increase in aortic PWV was noted in those patients treated with hemodialysis (9.5 ± 1.9 versus 10.2 ± 2.2 m/s, p < 0.01) as well as in those switched from hemodialysis to hemodiafiltration (9.4 ± 1.9 versus 10.1 ± 2.2 m/s, p < 0.01); in contrast, aortic PWV remained unchanged in the group of hemodiafiltration (9.9 ± 2.1 versus 10.1 ± 2.2 m/s) [38]. The most important finding of this study was that aortic PWV remained constant during follow-up only in those patients receiving long-term treatment with hemodiafiltration, whereas aortic PWV increased in patients who were switched from hemodialysis to hemodiafiltration.…”

Section: Long-term Effects Of Hemodiafiltration On Arterial Stiffnessmentioning

confidence: 91%

The Effect of Convective Dialytic Modalities on Arterial Stiffness in End-Stage Renal Disease Patients

Georgianos¹,

Dounousi²,

TheodorosEleftheriadis³

et al. 2016

Advances in Hemodiafiltration

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Abstract"mong end-stage renal disease ESRD patients receiving hemodialysis, increased arterial stiffness is an independent cardiovascular risk predictor. Over the past few years, arterial stiffness attenuation has been increasingly recognized as a novel therapeutic target toward cardiovascular risk reduction in the dialysis population. Structural alterations related to the long-term arteriosclerotic process are difficult to modify with the exception of blood pressure "P -lowering, there are no other therapeutic interventions with well-documented benefits in delaying the progression of arteriosclerosis among dialysis patients. Enhanced clearance of middle-to-high molecular weight solutes by combining convective and diffusive transport through hemodiafiltration and the associated benefits on microvascular endothelial function have generated the hypothesis that convective dialytic modalities may be advantageous in improving large-artery stiffness. This notion is supported by some clinical studies showing that switching ESRD patients from low-flux hemodialysis to highefficiency on-line hemodiafiltration was associated with significant reduction in arterial stiffness. These beneficial effects, however, were not confirmed in a recent subanalysis of the CONvective TR"nsport STudy CONTR"ST trial. In this chapter, we summarize the currently available evidence on the effect of hemodiafiltration versus hemodialysis on arterial stiffness, discussing also the potential clinical implications of this effect.

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“…Arterial stiffness was measured noninvasively in recumbent patients using a validated brachial oscillometric device (Arteriograph, TensioMed Ltd, Budapest, Hungary) (13) in a standardized manner in a temperature-controlled environment (14,15). The device requires a minimum of three sinus heart beats for analysis, and as such, patients with atrial fibrillation and other cardiac arrhythmias were excluded.…”

Section: Measurement Of Arterial Stiffnessmentioning

confidence: 99%

Changes in Vascular Tone Occur Early During Hemodialysis Treatments Independently of Volume Reduction

2015

Self Cite

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Hypotension commonly occurs during hemodialysis (HD). Hypotension can result from an absolute reduction in plasma volume following excessive ultrafiltration or from a reduction in vascular tone. We hypothesized that changes in vascular tone could occur during dialysis. Aortic pulse wave velocity (aPWV) was measured in 197 HD patients, mean age 63.3 ± 16.6 years, 62% male, 49% diabetic, during a single HD session. aPWV did not change (9.6 ± 2.2 vs. 9.6 ± 2.2 m/s) with HD. Systolic blood pressure (SBP) declined from 151 ± 31 to 147 ± 32 after 20 min and to 140 ± 36 mm Hg on completion of HD (P < 0.05), with an ultrafiltration volume of 2.2 ± 0.9 L over a 3.9 ± 0.4 h HD session. Aortic SBP declined from 154 ± 32 to 146 ± 29 after 20 min and 143 ± 35 at the end of HD, P < 0.001. Aortic augmentation index (Aortic Aix) decreased from 65% (52-79%) to 36.7% (23.3-52.9%) by 20 min and to 34.3 (15.1-49.1%) on completion of HD (P < 0.05), and brachial augmentation index (brachial Aix) from 5.7% (-25.2 to 27.5%) to -1.9% (-2.2 to 30.1%) and -6.6% (-44 to 22.7%), respectively, P < 0.05. Diastolic reflection area (DRA) increased from 36.7 (27.9-46.3) to 40.4 (32.2-51) after 20 min and 47.1 (34.2-60.5) on completion of HD, P < 0.05. We report changes in arterial tone within 20 min of starting HD, when minimal ultrafiltration has occurred, suggesting that volume changes may not be the only predisposing cause of intradialytic hypotension. The combination of a fall in SBP and a rise in DRA would suggest a reduction in coronary blood flow in keeping with reports of "myocardial stunning" during HD.

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Does hemodiafiltration reduce vascular stiffness measured by aortic pulse wave velocity compared with high‐flux hemodialysis?

Cited by 11 publications

References 23 publications

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

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

The Effect of Convective Dialytic Modalities on Arterial Stiffness in End-Stage Renal Disease Patients

Changes in Vascular Tone Occur Early During Hemodialysis Treatments Independently of Volume Reduction

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