Potential benefits of converting from short daily high-flux hemodialysis to short daily online hemodiafiltration: a pilot study.

INTRODUCTION

High-volume, conventional thrice-weekly hemodiafiltration appears to provide better outcomes than conventional hemodialysis. We aimed to evaluate whether the benefits of performing hemodiafiltration can be combined with those of frequent hemodialysis.

METHODS

This was a single-center, longitudinal, A1-B-A2 design study that compared high-flux short daily hemodialysis (SDHD) with post-dilution online short daily hemodiafiltration (SDHDF).

RESULTS

Twelve patients completed the study. Myoglobin clearance was greater during SDHDF (45.95 ± 11.0 mL/min) than during SDHD1 (20.11 ± 5.2 mL/min, P < 0.01) and SDHD2 (21.39 ± 3.55 mL/min, P < 0.01). A slightly higher pre-dialysis mean arterial pressure was observed during SDHDF (102.51 ± 11.28 mmHg) compared with SDHD1 (95.5 ± 9.82 mmHg, P < 0.01) and SDHD2 (97.61 ± 11.19 mmHg, P = 0.03). We also detected an increase in pre-dialysis hemoglobin during SDHDF (12.39 ± 1.2 g/dL) compared to SDHD1 (11.30 ± 1.09 g/dL, P = 0.02) and SDHD2 (11.23 ± 1.84 g/dL, P < 0.01). HDL-cholesterol was significantly higher at the end of the SDHDF period (52.75 ± 15.8 mg/dL) compared to SDHD1 (47.00 ± 10.8 mg/dL, P = 0.01) and SDHD2 (43.75 ± 11.1 mg/dL, P < 0.01) periods.

CONCLUSION

The effect of converting SDHD to SDHDF was slightly positive in our study. In the long term, short daily hemodiafiltration might have more benefits for the dialysis population. This can lead to the adoption of hemodiafiltration as the standard of care even in the frequent hemodialysis setting.