Hemofiltration and Hemodiafiltration Reduce Intradialytic Hypotension in ESRD

Locatelli, Francesco; Altieri, Paolo; Andrulli, Simeone; Bolasco, Piergiorgio; Sau, Giovanna; Pedrini, Luciano A.; Basile, Carlo; David, S.; Feriani, M; Montagna, G.; Iorio, Biagio Raffaele Di; Memoli, Bruno; Cravero, Raffaella; Battaglia, Giovanni Giorgio; Zoccali, Carmine

doi:10.1681/asn.2010030280

Cited by 244 publications

(226 citation statements)

References 28 publications

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“…It was recently shown that the application of convective therapy was associated with better intradialytic hemodynamic stability. 19 Other aspects, such as quality of life, erythropoietin resistance, vascular stiffness, left ventricular mass, nutritional status, and cost utility, are currently under investigation as predefined secondary endpoints of this study. 20,21 The strengths of our study are its randomized design and the accurate and concise data collection.…”

Section: Discussionmentioning

confidence: 99%

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Grooteman

Dorpel

Bots

et al. 2012

Journal of the American Society of Nephrology

463

423

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In patients with ESRD, the effects of online hemodiafiltration on all-cause mortality and cardiovascular events are unclear. In this prospective study, we randomly assigned 714 chronic hemodialysis patients to online postdilution hemodiafiltration (n=358) or to continue low-flux hemodialysis (n=356). The primary outcome measure was all-cause mortality. The main secondary endpoint was a composite of major cardiovascular events, including death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, therapeutic coronary intervention, therapeutic carotid intervention, vascular intervention, or amputation. After a mean 3.0 years of follow-up (range, 0.4-6.6 years), we did not detect a significant difference between treatment groups with regard to all-cause mortality (121 versus 127 deaths per 1000 person-years in the online hemodiafiltration and low-flux hemodialysis groups, respectively; hazard ratio, 0.95; 95% confidence interval, 0.75-1.20). The incidences of cardiovascular events were 127 and 116 per 1000 person-years, respectively (hazard ratio, 1.07; 95% confidence interval, 0.83-1.39). Receiving highvolume hemodiafiltration during the trial associated with lower all-cause mortality, a finding that persisted after adjusting for potential confounders and dialysis facility. In conclusion, this trial did not detect a beneficial effect of hemodiafiltration on all-cause mortality and cardiovascular events compared with low-flux hemodialysis. On-treatment analysis suggests the possibility of a survival benefit among patients who receive high-volume hemodiafiltration, although this subgroup finding requires confirmation.

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Section: Discussionmentioning

confidence: 99%

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Grooteman

Dorpel

Bots

et al. 2012

Journal of the American Society of Nephrology

463

423

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“…Such investigations may focus on patient sodium exposure from dialysate and diet or other strategies to mitigate IDWG. Current studies are looking at biofeedback or medication to control BP during dialysis, dialysate cooling, and increasing the frequency of dialysis to lower ultrafiltration rates and volumes (4,(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Intradialytic Hypotension and Risk of Cardiovascular Disease

Stefánsson

Brunelli

Cabrera

et al. 2014

Clinical Journal of the American Society of Nephrology

264

192

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Background and objectives Patients undergoing hemodialysis have an elevated risk of cardiovascular diseaserelated morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role.

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“…Although these studies were designed to evaluate outcomes of arterial blood pressure and intrasession symptoms, no differences were observed in presession P levels, and no superiority of HF compared to HDF was observed. 19,20 Since the end of the 1990s, a new hemodialytic method was introduced that employed three types of depuration: convection; adsorption by resins; and diffusion. 21 An ultrafiltrate is formed by the plasma water leaving the convective filter, and it is conveyed into a cartridge containing adsorbents (polystyrenic resin), which retain various high molecular-weight toxic substances.…”

Section: Convective Hemodialysis Techniquesmentioning

confidence: 99%

Phosphate control in dialysis

Cupisti¹,

Gallieni²,

Rizzo³

et al. 2013

IJNRD

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Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

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Hemofiltration and Hemodiafiltration Reduce Intradialytic Hypotension in ESRD

Cited by 244 publications

References 28 publications

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Intradialytic Hypotension and Risk of Cardiovascular Disease

Phosphate control in dialysis

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