TITLE:
Effect of On-Line Hemodiafiltration on Dry Weight Adjustment in Intradialytic Hypotension-Prone Patients: Comparative Study of Conventional Hemodialysis and On-Line Hemodiafiltration
AUTHORS:
Sun Woo Kang
KEYWORDS:
On-Line Hemodiafiltration; Hemodialysis; Intradialytic Hypotension; Body Composition Monitor; Dry Body Weight
JOURNAL NAME:
Open Journal of Nephrology,
Vol.4 No.1,
March
7,
2014
ABSTRACT: Introduction: Correct adjustment of dry weight after
hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic
hypotension (IDH) is the most common complication during HD. IDH occurs in 15%
to 30% and possibly in up to 50% of dialysis sessions. IDH augments mortality
essentially due to chronic overhydration and the inability to reach the proper
dry weight. On-line hemodiafiltration (ol-HDF) has been reported to reduce the
frequency of IDH. The aim of this study was to assess the effect of ol-HDF on
hemodynamic stability and dry weight adjustment compared with low-flux HD.
Methods: IDH-prone HD patients at our center were enrolled. This study was
designed as a crossover trial with two phases (A arm: low-flux HD for 8 weeks
followed by ol-HDF for 8 weeks vs. B
arm: ol-HDF for 8 weeks followed by low-flux HD for 8 weeks) and two treatment
arms (ol-HDF vs. low-flux HD), each
phase lasting 8 weeks. We measured the proportion of body water using a body
composition monitor (BCM). Results: In a comparison of the systolic blood
pressure (SBP) and diastolic blood pressure (DBP) reductions from the baseline
blood pressure between the HD and ol-HDF groups, statistically significant
differences were observed only in the SBP of the B arm (SBP: HD vs. HDF, -9.83 ± 6.64 vs. -4.62 ± 1.61 mmHg, p = 0.036; DBP:
HD vs. HDF, -3.29 ± 4.05 vs. -1.86 ± 1.49 mmHg, p = 0.261).
Neither the mean of the interdialytic body weight gains nor the frequency of
IDH was different between the A and B arms (p = 0.817 and p = 0.562,
respectively). In terms of dialysis modality, there were no significant
differences in the amount of overhydration between the conventional HD and
ol-HDF groups during the two study phases, as measured by the BCM (A arm: p =
0.875, B arm: p = 0.655). Conclusion: Our study did not show a better benefit
of ol-HDF to reach the dry weight compared with low-flux HD in IDH-prone patients.