Comparison of Physical Function in Hemodialysis Patients Treated with Medium Cut-Off Dialyzers, High-Flux Dialyzers, and Hemodiafiltration.

INTRODUCTION

All dialysis modalities can potentially improve physical activity levels and patient well-being, primarily through better toxin clearance. We sought to assess the impact of medium cut-off hemodialysis (MCO-HD), high-flux hemodialysis (HF-HD), and high-flux hemodiafiltration (HF-HDF) on quantitative physical performance measures, which are prognostic for quality of life and mortality risk.

METHODS

Ten maintenance hemodialysis patients received MCO-HD, HF-HD, and HF-HDF, each for a duration of 6 months. Outcomes encompassed alterations in physical activity levels, assessed with the International Physical Activity Questionnaire, and physical performance, evaluated through the 5-times sit-to-stand, 4-meter gait speed, grip strength tests, and bioelectrical impedance analysis.

RESULTS

The cohort comprised 7 men and 3 women with a median dialysis vintage of 96 months (IQR: 36). Dialysis adequacy (single-pool KtV ≥1.2) was attained across all modalities for 18 months, with no notable alterations in nutritional and inflammation markers, including serum albumin. Self-reported physical activity improved during MCO-HD (total MET min/week 234.5 [IQR: 1,188] vs. 1,229.5 [IQR: 1,683], p = 0.019). There were no significant changes in handgrip strength, gait speed, or muscle mass in either group, nor were there any notable differences between the groups. The 5-times sit-to-stand test has shown stability in the MCO-HD group, whereas a substantial enhancement over 6 months observed with the HF-HDF (12.34 [IQR: 3.88] vs. 10.18 [IQR: 3.14] seconds, p = 0.022]).

CONCLUSION

The MCO-HD group reported elevated physical activity levels, while the HF-HDF group demonstrated considerable enhancement in low extremity strength. The patient-centered selection of dialysis modality, including the implementation of exercises and nutritional interventions, may improve physical performance and patient outcomes.