Effect of On-Line Hemodiafiltration on Dry Weight Adjustment in Intradialytic Hypotension-Prone Patients: Comparative Study of Conventional Hemodialysis and On-Line Hemodiafiltration

DOI: 10.4236/ojneph.2014.41001    3,887 Downloads   5,308 Views  
Author(s)    Leave a comment

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.

Cite this paper

S. Kang, "Effect of On-Line Hemodiafiltration on Dry Weight Adjustment in Intradialytic Hypotension-Prone Patients: Comparative Study of Conventional Hemodialysis and On-Line Hemodiafiltration," Open Journal of Nephrology, Vol. 4 No. 1, 2014, pp. 1-7. doi: 10.4236/ojneph.2014.41001.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Chamney, P.W., Krämer, M., Rode, C., Kleinekofort, W. and Wizemann, V. (2002) A New Technique for Establishing Dry Weight in Hemodialysis Patients via Whole Body Bioimpedance. Kidney International, 61, 2250-2258.
http://dx.doi.org/10.1046/j.1523-1755.2002.00377.x
[2] Ozkahya, M., Ok, E., Toz, H., et al. (2006) Long-Term Survival Rates in Haemodialysis Patients Treated with Strict Volume Control. Nephrology Dialysis Transplantation, 21, 3506-3513. http://dx.doi.org/10.1093/ndt/gfl487
[3] Reddan, D.N., Szczech, L.A., Hasselblad, V., et al. (2005) Intradialytic Blood Volume Monitoring in Ambulatory Hemodialysis Patients: A Randomized Trial. Journal of the American Society of Nephrology, 16, 2162-2169.
http://dx.doi.org/10.1681/ASN.2004121053
[4] Agarwal, R., Alborzi, P., Satyan, S. and Light, R.P. (2009) Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP) A Randomized, Controlled Trial. Hypertension, 53, 500-507.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.125674
[5] Jirka, T., Cesare, S., Di Benedetto, A., et al. (2006) Mortality Risk for Patients Receiving Hemodiafiltration versus Hemodialysis. Kidney International, 70, 1524-1524. http://dx.doi.org/10.1038/sj.ki.5001759
[6] Canaud, B., Bragg-Gresham, J., Marshall, M., et al. (2006) Mortality Risk for Patients Receiving Hemodiafiltration versus Hemodialysis: European Results from the DOPPS. Kidney International, 69, 2087-2093.
http://dx.doi.org/10.1038/sj.ki.5000447
[7] Panichi, V., Rizza, G.M., Paoletti, S., et al. (2008) Chronic Inflammation and Mortality in Haemodialysis: Effect of Different Renal Replacement Therapies. Results from the RISCAVID Study. Nephrology Dialysis Transplantation, 23, 2337-2343. http://dx.doi.org/10.1093/ndt/gfm951
[8] Vilar, E., Fry, A.C., Wellsted, D., Tattersall, J.E., Greenwood, R.N. and Farrington, K. (2009) Long-Term Outcomes in Online Hemodiafiltration and High-Flux Hemodialysis: A Comparative Analysis. Clinical Journal of the American Society of Nephrology, 4, 1944-1953. http://dx.doi.org/10.2215/CJN.05560809
[9] Locatelli, F., Altieri, P., Andrulli, S., et al. (2010) Hemofiltration and Hemodiafiltration Reduce Intradialytic Hypotension in ESRD. Journal of the American Society of Nephrology, 21, 1798-1807.
http://dx.doi.org/10.1681/ASN.2010030280
[10] Moissl, U.M., Wabel, P., Chamney, P.W., et al. (2006) Body Fluid Volume Determination via Body Composition Spectroscopy in Health and Disease. Physiological Measurement, 27, 921.
http://dx.doi.org/10.1088/0967-3334/27/9/012
[11] Wabel, P., Moissl, U., Chamney, P., et al. (2008) Towards Improved Cardiovascular Management: The Necessity of Combining Blood Pressure and Fluid Overload. Nephrology Dialysis Transplantation, 23, 2965-2971.
http://dx.doi.org/10.1093/ndt/gfn228
[12] Van Biesen, W., Williams, J.D., Covic, A.C., et al. (2011) Fluid Status in Peritoneal Dialysis Patients: The European Body Composition Monitoring (EuroBCM) Study Cohort. PLoS One, 6, Article ID: e17148.
http://dx.doi.org/10.1371/journal.pone.0017148
[13] Machek, P., Jirka, T., Moissl, U., Chamney, P. and Wabel, P. (2010) Guided Optimization of Fluid Status in Haemodialysis Patients. Nephrology Dialysis Transplantation, 25, 538-544. http://dx.doi.org/10.1093/ndt/gfp487
[14] Onofriescu, M., Mardare, N.G., Segall, L., et al. (2012) Randomized Trial of Bioelectrical Impedance Analysis versus Clinical Criteria for Guiding Ultrafiltration in Hemodialysis Patients: Effects on Blood Pressure, Hydration Status, and Arterial Stiffness. International Urology and Nephrology, 44, 583-591. http://dx.doi.org/10.1007/s11255-011-0022-y
[15] Santoro, A., Mancini, E., Basile, C., et al. (2002) Blood Volume Controlled Hemodialysis in Hypotension-Prone Patients: A Randomized, Multicenter Controlled Trial. Kidney International, 62, 1034-1045.
http://dx.doi.org/10.1046/j.1523-1755.2002.00511.x

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.