Long-Term Outcomes in Online Hemodiafiltration and High-Flux Hemodialysis : A Comparative Analysis
Background and objectives: Theoretical advantages exist of online hemodiafiltration (HDF) over high-flux hemodialysis (HD), but outcome data are scarce. Our objective was to compare outcomes between these modalities. Design, setting, participants, & measurements: We studied 858 incident patients in our incremental high-flux HD and online HDF program during an 18-yr period. We compared outcomes, including survival, in those who were treated predominantly with HDF (>50% sessions) and those with high-flux HD. Survival comparisons used a Cox model taking into account the time-varying proportion of time spent on HDF. All data were prospectively collected. Results: A total of 152,043 sessions were delivered as HDF and 291,222 as high-flux HD. A total of 232 (27%) patients were treated predominantly with HDF and 626 (73%) with high-flux HD. Total Kt/V, serum albumin, erythropoietin resistance index, and BP were similar in both groups up to 5 yr after HD initiation. Intradialytic hypotension was less frequent in the predominant HDF group. Predominant HDF treatment was associated with a reduced risk for death after correction for confounding variables. In a second Cox model, proportion of time spent on HDF predicted survival, such that patients who were treated solely by HDF would have a hazard for death of 0.66 compared with those who solely used high-flux HD. Conclusions: We found no benefits of HDF over high-flux HD with respect to anemia management, nutrition, mineral metabolism, and BP control. The mortality benefit associated with HDF requires confirmation in large randomized, controlled trials. These data may contribute to their design.
Item Type | Article |
---|---|
Uncontrolled Keywords | dialysis |
Date Deposited | 26 Jul 2024 13:51 |
Last Modified | 26 Jul 2024 13:51 |
Explore Further
Read more research from the creator(s):
Find work associated with the faculties and division(s):
- School of Life and Medical Sciences
- Department of Psychology
- Health & Human Sciences Research Institute
- Centre for Lifespan and Chronic Illness Research
- Psychology
- Health Services and Medicine
- Applied and Practice-based Research
- Health and Clinical Psychology Research Group
- Centre for Health Services and Clinical Research
- Department of Pharmacy, Pharmacology and Postgraduate Medicine