High-volume online haemodiafiltration improves erythropoiesis-stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study

Panichi, Vincenzo; Scatena, Alessia; Rosati, Alberto; Giusti, Riccardo; Ferrò, Giuseppe; Malagnino, Erasmo; Capitanini, Alessandro; Piluso, A.; Conti, Paolo; Bernabini, Giada; Migliori, Massimiliano; Caiani, David; Tetta, Ciro; Casani, Aldo; Betti, G.; Pizzarelli, Francesco

doi:10.1093/ndt/gfu345

Cited by 77 publications

(91 citation statements)

References 42 publications

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“…The clearance is mild in low-flux HD, intermediate by high-flux HD, and elevated in OL-HDF. Recently, we demonstrated that the use of new HD techniques and more efficient membranes that allow higher convective volume, allow the removal of larger quantities of hepcidin with a significant reduction in pre- HD levels and a consensual improvement of ESAs resistance [33]. Also Stefansson et al [34], in a short-term study consisting of a small population of 20 patients, suggested that hepcidin levels were significantly reduced after 60 days of high volume OL-HDF with respect to low-flux HD.…”

Section: Current Strategies To Improve Esa Hyporesponsivenessmentioning

confidence: 99%

“…Small sample size randomized studies except Ward et al [39] showed an improvement of ERI or a reduction in ESAs consumption in post dilution OL-HDF (Lin et al [40], Vaslaki et al [41], Schiffl [42], Pedrini et al [43], and Panichi et al [33]). The study from Ward et al [39] failed to find a significant difference between online HDF and high-flux dialysis regarding the ERI but the sample size was very small, and the groups were not well balanced, particularly for the prevalence of polycystic kidney disease (8.3% in the HDF group vs. 23.8% in the HD group).…”

Section: Randomized and Observational Studiesmentioning

confidence: 99%

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Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

2018

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Hyporesponsiveness to erythropoietin stimulating agents (ESAs) is a condition associated with increased mortality. Even after identifying the condition, the causes are difficult to treat and only partially reversible in end-stage renal disease patients. Thus, the role of more recent hemodialysis (HD) techniques in improving such conditions is an emerging issue. However, major randomized clinical trials have not confirmed the results of smaller observational studies in which online hemodiafiltration has shown some efficacy in improving patients’ response to ESAs. In our interpretation, these findings are not in contrast, but they can be explained by a better understanding of the interactions between HD and ESAs on iron mobilization, first of all through the role of hepcidin. The kinetics of hepcidin removal through HD combined with the action of selected ESAs may help the clinician in prescribing the best association between HD treatment and ESAs to overcome hyporesponsiveness.

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Section: Current Strategies To Improve Esa Hyporesponsivenessmentioning

confidence: 99%

Section: Randomized and Observational Studiesmentioning

confidence: 99%

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

2018

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“…Many clinical effects for online HDF have been reported. These include the reduction of dialysis-related hypotension [6], improvement of anemia with sparing erythropoiesis-stimulating agent dosage [7,8,9], prevention of the deterioration of dialysis-related amyloidosis, improvement of the nutritional status by reducing inflammatory stress [10], cardiovascular protection by preserving vascular endothelial cell function [11,12], relief of both peripheral neuropathy and insomnia [13,14], preservation of residual renal function [15] and ultimately a survival benefit [3]. These effects are due to the better quality of dialysis fluid, the greater efficiency of removing uremic accumulates and the better hemodynamic stability during treatment resulting in prevention of dialysis-related hypotension.…”

Section: Expectation For Online Hdf From the Japanese Perspectivementioning

confidence: 99%

“…Increased phosphate removal, which was not found by the Italian group [19], is also expected to affect the serum calcification propensity and levels of calcified protein particles which are strongly related to the ectopic vascular calcification in ESRD patients. In addition, hepcidin removal is an important mechanism for the better management of anemia [9]. …”

Section: Clinical Effect Of Online Hdf: Further Expectationsmentioning

confidence: 99%

Clinical Expectation of Online Hemodiafiltration: A Japanese Perspective

Akizawa

Koiwa

2015

Blood Purif

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Many pieces of evidence of online hemodiafiltration (HDF) have been reported, and the clinical advantage of postdilution online HDF with sufficient substitution is now established. After the approval of online HDF in 2012, the number of online HDF patients has been dramatically increasing in Japan and reached 10% of the total dialysis population at the end of 2013. One of the marked characteristics of Japanese online HDF is a widespread use of predilution treatment and, in 2013, 90.8% of online HDFs were carried out with the predilution mode. The main reason for the wide use of predilution online HDF results from the low blood flow rate in Japan, by which it is difficult to substitute a sufficient volume during the limited treatment time. Other reasons to choose the predilution mode include the reduction of albumin loss and the suppression of membrane fouling during treatment. Contrary to postdilution treatment, adequate clinical evidence has not been reported for predilution online HDF to provide a better outcome of the patients. A further clinical trial is expected to elucidate the clinical advantages over conventional hemodialysis for predilution online HDF.

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“…The benefit was attributed to the combined effects of the higher removal of middle-sized toxins (erythropoietic inhibitor substances) and reduced inflammation due to the use of higher-quality water and dialysis fluid [47,48]. However, this effect was not confirmed in a recent meta-analysis [49].…”

Section: Inflammation Oxidative Stress and Anemiamentioning

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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High-volume online haemodiafiltration improves erythropoiesis-stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study

Cited by 77 publications

References 42 publications

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

Clinical Expectation of Online Hemodiafiltration: A Japanese Perspective

Update on Clinical Evidence Supporting Hemodiafiltration

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