PROSPECTIVE STUDY COMPARING EFFICACY AND COST EFFECTIVENESS OF HEMODIAFILTRATION VS CONVENTIONAL HEMODIALYSIS IN A TERTIARY CARE CENTRE

Introduction:

Hemodialysis can be subdivided into 3 major subtypes: low flux hemodialysis (lf-HD), high flux hemodialysis (hf-HD) and hemodiafiltration [HDF].Conventional hemodialysis works on the principle of diffusion alone. The technique of hemodiafiltration (HDF) has been an alternative to hemodialysis since early 1970. It offers good solute clearance and better cardiovascular stability. The concept of HDF is a combination of diffusive and convective transport within a single treatment session. While offering good small molecule clearance it has the potential added benefits of improved larger molecule clearance and better cardiovascular stability. Clearance of small sized molecules like phosphate and middle sized molecules like beta 2 glycoprotein is better with hemodiafiltration than hemodialysis. Various studies have been conducted in different countries comparing HDF with HD, however there is very little data in our country.

Methods:

This hospital-based prospective observational study which included all adult CKD patients (Age >18 years) undergoing maintenance dialysis. Patients with past renal transplantation, planned renal transplant in the next 6 months, active malignancy, serology positive patients like active hepatitis B, hepatitis C and HIV positive patients were excluded from the study population. Patients were divided into HDF and HD groups after evenly matching them. Blood parameters and quality of life index were measured at 0, 3, 6 and 12 months. Blood samples were obtained pre-dialysis, otherwise specified. Blood flow and dialysate flow was matched between the 2 groups. Cost analysis was evaluated based on the cost incurred for out-patient treatment. Quality of life was assessed by Kidney Disease and Quality of Life (KDQOLTM-36) questionnaire. All data were extracted into excel sheet and analysed. Chi-square & t-tests were used to compare efficacy, cost-effectiveness and quality of life between hemodiafiltration and conventional hemodialysis patients. p-value of <0.05 was considered significant.

Results:

32 patients were recruited in the study, 20 in HD group and 12 patients in the HDF group based on qualitative variable formula. Both group were similar with respect to demographic characters (age/gender/age distribution), prevalence of comorbidities and native kidney disease. HDF patients as compared to HD patients had better solute clearance for substances like urea, potassium and phosphate and it was statistically significant. HDF patients had better urea reduction ratio (URR) than those patients who were on conventional hemodialysis. Cost incurred per month was more in HDF patients as compared to HD patients. Although the monthly expenditure was more in HDF patients, in our study HDF patients had fewer rates of hospitalization. Study found no significant difference in levels of serum beta 2 microglobulin levels in patients undergoing HDF vs conventional hemodialysis. Quality of life in both groups was comparatively the same as assessed by Quality of life – short form questionnaire.

Conclusions:

Patients in HDF group had better solute clearance, lesser need for hospitalization as compared to conventional hemodialysis patients. HDF patients had more monthly expenditure as compared to patients on conventional hemodialysis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.