Introduction:
Patients with end stage renal disease (ESRD) face nutritional challenges and reduced quality of life (QoL) due to inflammation, oxidative stress, hormonal imbalances, and toxin retention. Compared with conventional hemodialysis (HD), online hemodiafiltration (OL-HDF) offers enhanced removal of uremic toxins and reduces inflammation, potentially improving nutritional status. However, the supporting evidence is mixed. This aimed to study the clinical impact of high volume HDF on nutrition and QoL.
Methods:
This prospective study was conducted among adult patients (>18 years) with ESRD undergoing HDF at Shrimann Superspeciality Hospital, Punjab from January to July 2024. Data collected included patient demographics, comorbidities, dialysis vintage, and medical history including infection and hospitalizations episodes. Additionally, laboratory measurements and real-time dialysis parameters were recorded. QoL was assessed at intervals of three months by three different independent psychologists using short form health survey questionnaire (SF-36) and nutrition was assessed independently by a qualified dietician using subjective global assessment (SGA).
Results:
A total of 40 patients were included in this study. The majority of patients were men (70.0%). There were 32 patients with comorbidities, of which 27 had hypertension and 23 had type II diabetes mellitus. The average duration of dialysis was 39.6 months. The target volume of ≥23 L per session for high-dose convection was achieved in 62.5% of the HDF sessions. Patients from the effective convective volume (ECV) ≥23 L group had higher serum iron (60.1 μg/dL vs. 42.6 μg/dL; P=0.016) and albumin levels (4.0 g/dL vs. 3.6 g/dL; P=0.039) than those with lower convection volumes (ECV <23 L). The incidence of intradialytic hypotension was higher in the <23 L group compared to those with ≥23 L (33.3% vs. 28.0%). The majority of patients from both groups were well nourished (ECV ≥23 L: n=15 and ECV <23 L: n = 9). Among the laboratory parameters, protein levels showed a significant difference at both time points (3 months: P = 0.031; and 6 months: P = 0.002). At the 3-month visit, the QoL score for overall health (OH) increased from 75.8 to 102.0, with a mean difference of -26.2 [95% Confidence Interval (CI): -73.2 to 20.7; P=0.266] which further improved to 104.0, with a mean difference of -28.2 (95% CI: -75.1 to 18.7; P=0.231) from the 1-month visit [Figure 1 (A)]. For overall sleep (OS), the QoL score increased from 77.0 to 105.5 at the 3-month visit, showing a mean difference of -28.5 (95% CI: -75.4 to 18.5; P=0.227), which further improved to 106.7 with a mean difference of -29.7 (95% CI: -76.5 to 17.1; P=0.207) from the 1-month visit [Figure 1 (B)]. Patients with a dialysis duration of ≤36 months had a slightly higher average OH-related QoL score compared to those with a dialysis vintage of >36 months (84.4 vs. 73.3). Similarly, patients with ≤36 months of dialysis had higher average OS-related QoL scores compared to those with >36 months (87.4 vs. 75.8).
Conclusions:
This study on dialysis-dependent ESRD patients reveals that high-volume HDF with a convection volume of ≥23 L offers potential benefits in nutritional status and QoL, even though achieving optimal convection volume is challenging.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.