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On-line Hemodiafiltration is not Superior to High-Flux Hemodialysis, When Both Are Performed Six Times a Week

Short daily on-line hemodiafiltration (SDHDF) doesn’t improve outcomes of short daily high-flux hemodialysis (SDHD), a new study finds. The results are being presented at the 58th ERA-EDTA Congress on a fully virtual platform in June 5-8, 2021.


“In this study we attempted to determine if SDHDF improves clinical, laboratory, echocardiographic and quality of life features of patients already being treated with SDHD”, said the study lead author Natalia Melo, MD, nephrologist, Centro Brasiliense de Nefrologia & Dialise (CBN&D), in Brasilia, Brazil. “We found that in spite of mild increase of predialysis mean arterial pressure and hemoglobin levels along with greater removal of middle molecular weight solutes, there were no evidences of clinically meaningful benefit from on-line hemodiafiltration over high-flux hemodialysis, both performed six times a week.”


Short daily hemodialysis (SDHD) has improved outcomes observed in conventional thrice-weekly hemodialysis (CHD). Similarly, short daily hemodiafiltration (SDHDF) has also improved outcomes observed in conventional thrice-weekly hemodiafiltration (CHDF).


“But while high-volume CHDF has been proclaimed to be superior to CHD, there had been no studies comparing SDHDF to SDHD”, said Lucio Isoni, MD, study’s coauthor.  “It matters a great deal to know which is the case, as we hope to offer an optimal dialysis treatment. Thus, we performed such a comparison at the CBN&D Biosphere Unit”.


They studied twelve patients with mean age of 60.8±15.4 years on regular in-center SDHD for at least 6 months before conversion to SDHDF for 6 months. Following that, all patients were switched back to SDHD for another 6 months. At the end of each 6-month period, data were collected and compared.


Juliane Lauar, MD, CBN&D Medical Director and the study coauthor, states that “due to the long-term CBN&D in-center short daily hemodialysis program, we were able to carry out a two-treatment three-period A-B-A study design, in which each patient served as his or her own control. After the 18-month trial duration, we could conclude that online SDHDF patients had no better outcomes than high-flux SDHD patients.”


“We are excited to be sharing these data with the entire renal care community, in a time of search for the best dialysis treatment”, said Istenio Pascoal, MD, also study’s coauthor and CBN&D Administrative Director. “Conceptual changes and technological developments need to be challenged on relevant grounds. Regarding choice of hemodialysis modality, it seems clear that frequency might be more important than technique, as far as clinical outcomes are concerned.”


Study coauthors include Rossana Simoes (Nurse), Ludimila Allemand (Psychologist) and Daniel Vasconcelos, MD.


Read the Abstract: Investigations into Differences and Similarities Between Short Daily High-flux Hemodialysis and Short Daily On-line Hemodiafiltration



Click here to see the Presentation


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