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In hemodialysis patients online hemodiafiltration (HDF) is considered to confer clinical benefits over high-flux hemodialysis (HD) in terms of solute removal, anemia management, nutrition, morbidity and mortality. The aim of the study was to compare the data relating to HD adequacy, anemia management, phosphate control, and nutrition in patients during HDF and HD.
The multicenter observational prospective study enrolled 56 patients (47 M and 9 F) with the average age 52,66±11,9 years and the average HD vintage 77,46±49,6 months. The follow-up period was 27 months, with the mean duration 24,23±5,18 months, range 12-27 months. Over the first 6 months the patients were on high-flux HD (HD period), and over the next months on online postdilution HDF (HDF period with the mean duration 18,23±5,18 months, range 6-21 months, and average substitution volume 22,67±3,37 L). The following clinical and laboratory parameters were recorded either monthly (HD adequacy parameters eKt/V and Urea reduction ratio-URR, Hemoglobin, Epoetin dose, and s-phosphate), or at 3 months (s-albumin, normalized Protein Catabolic Rate- nPCR, and BMI), and time averaged values were compared between two periods after 6 months HDF period and at the end of the HDF study period. Statistical analysis was performed by software SPSS, the data are displayed as a percentage, mean values and standard deviation, continued variables were analyzed with repeated measures analysis of variance and multiple linear regression model, but categorical variables with Chi-Square test.
With regard to HD adequacy parameters statistically significant higher eKt/V and URR were recorded after 6 months HDF period and at the end of the HDF period compared to HD period (eKt/V: HDFend=1,41±0,14 vs HD=1,32±0,08; p=0.001, and URR(%): HDFend=74,37±3,34 vs HD=72,19±2,62; p=0.002). The statistically significant higher mean hemoglobin (HDFend= 118,48±6,86 vs HD=116,42±8,95 g/L; p= 0.043) at a significantly lower mean erythropoietin dose (HDFend= 3807,2±2926,5 vs HD= 4797,7±3148,7 IU/week, p=0.004) were recorded after 6 months HDF period and at the end of the HDF period compared to HD period. There was statistically significant lower mean s-phosphate after 6 months HDF period and at the end of the HDF period compared to HD period (HDFend=1,62±0,34 vs HD=1,7±0,36 mmol/L; p=0.031). Regarding nutrition parameters statistically significant higher mean s-albumin at the end of the HDF period compared to HD period and after 6 months HDF period was recorded (HDFend=41,64±3,36 vs HD=37,46±2,73 g/L; p<0.001), but nPCR (HDFend=0,96±0,18 vs HD=0,94±0,19 g/kg/day; n.s.) and BMI (HDFend=29,58±5,84 vs HD=29,32±5,79; n.s) were nonsignificantly higher at the end of the HDF period compared to HD period. The statistically significant predictors of s-albumin at the end of the HDF period by multiple linear regression model (R square=0,23; p=0.02) were HDF period (Beta=0,411; p=0.011) and hemoglobin (Beta=0,318; p=0.036).
Online HDF compared to high-flux HD demonstrate statistically significant beneficial effects regarding HD adequacy, anemia management, s-phosphate control and nutrition with higher s-albumin that contribute to improved quality of life and outcome of hemodialysis patients.