Is high-volume post-dilution haemodiafiltration associated with risk of fluid volume imbalance? A national multicentre cross-sectional cohort study

Abstract

Background Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers. Method This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®. Results 2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Comparing the HD and OL-HDF groups, there was no difference between HD and OL-HDF patients regarding the predialysis systolic BP, the interdialytic weight gain, the dialysate-plasma sodium gradient, and the predialysis RelFO%. The stepwise logistic regression did not find dialysis modality (HD or OL-HDF) associated with fluid overload or high predialysis systolic blood pressure. In OL-HDF patients, monthly average convective or weekly infusion volumes per session were not related with the presence of fluid overload. Conclusions In this cross-sectional study we did not find association between the use of post-dilution OL-HDF and markers of fluid volume excess. Aligned dialysis fluid sodium concentrations to patient predialysis plasma sodium and regular monitoring of fluid volume status by bioimpedance spectroscopy may have been helpful to manage adequately the fluid status in both OL-HDF and HD patients.

Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high‐flux hemodialysis versus online hemodiafiltration

“…An additional point of interest of our findings is the fact that sodium mass removal in high‐volume ol‐HDF is almost similar to that one achieved in hf‐HD. This is in agreement with recent studies addressing this concern 16,17 . As shown in our study, net sodium mass balance is virtually similar in both dialysis modalities (−222.6 vs. −235.3 mmol/session using the Flux model) on a dialysis session basis but also on a weekly cumulative basis.…”

“…This is in agreement with recent studies addressing this concern. 16,17 As shown in our study, net sodium mass balance is virtually similar in both dialysis modalities (−222.6 vs. −235.3 mmol/session using the Flux model) on a dialysis session basis but also on a weekly cumulative basis. Interestingly, the Flux model clearly shows that sodium mass removal is mainly obtained by convection in hf-HD and ol-HDF.…”

Impact of First Wave COVID-19 Crisis on Dialysis Parameters of COVID-Free Hemodialysis Patients: A NephoCare France Longitudinal Retrospective Cohort Study

“…The medical management of NC units is run in partnership with 64 nephrologists (62 with private status and 2 NC employees). The dialysis prescription and dialysis parameters are run on the common software EUCLID 5 connected to the dialysis stations as reported previously [ 6 ]. During the study period, the management of COVID-19+ HD patients without the need of intensive care because of respiratory failure was organized at unit level.…”

Why and how high volume hemodiafiltration may reduce cardiovascular mortality in stage 5 chronic kidney disease dialysis patients? A comprehensive literature review on mechanisms involved

“…prevalent French dialysis patients, 56 and a randomized cross-over trial of HD and HDF in 20 IDH prone patients, which although the decline in intradialytic blood pressure from baseline was statistically less in the HDF group, there was no significant advantage of HDF in reaching the target weight. 57 In addition, on long term, peridialytic hemodynamic profile, as represented by pre-and post-dialysis blood pressure values, were not significantly different between HD and HDF treated groups as indicated by a recent finding of a large individual personal data metaanalysis.…”