Kidney international reports · 2025
Randomized Trial of Twice-Weekly Versus Thrice-Weekly Hemodiafiltration for Initiation of Renal Replacement Therapy.
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Fernández Lucas Milagros, Muriel Alfonso, Mendiola Nuria Rodríguez, Merino Jose Luis, Collado Andrea, Díaz Domínguez Martha Elizabeth, Ruíz-Roso Gloria, Sánchez Rafáel, Herrero Jose Antonio, Bouarich Hanane, López de la Manzanara Virginia, Zamora Javier
Аннотация
INTRODUCTION: This study presents the first randomized controlled trial (RCT) comparing incremental hemodiafiltration (HDF) (i-HDF), beginning with twice-weekly sessions, to conventional thrice-weekly HDF (c-HDF) in incident dialysis patients with preserved residual kidney function (RKF): urea clearance (KrU) ≥ 2.5 ml/min.
METHODS: In this multicenter, open-label trial, 150 patients were randomized 1:1 to either i-HDF (n = 77) or c-HDF (n = 73), regardless of comorbidity burden. The primary outcome was the decline in glomerular filtration rate (GFR) over 12 months. Secondary outcomes included changes in RKF (measured by 24-hour urine output, KrU, and creatinine clearance [KrCr]), incidence of anuria, hospital admissions, mortality, quality of life (using the Kidney Disease Quality of Life-36), and the total number of HDF sessions.
RESULTS: No significant differences were found between groups in GFR decline, RKF parameters, or clinical outcomes such as hospitalizations, mortality, or anuria (5 cases in i-HDF vs. 4 in c-HDF). At 6 months, the i-HDF group reported slight improvements in quality of life, particularly in disease burden domains, though these gains diminished by 12 months. Fifteen patients in the i-HDF group transitioned to thrice-weekly HDF after an average of 193 days, and none refused the increase in frequency when indicated. The i-HDF group received significantly fewer dialysis sessions annually (69.1 vs. 122.6).
CONCLUSION: Incremental HDF is a safe and effective option for patients with preserved RKF, offering similar clinical outcomes to conventional schedules, with modest short-term quality-of-life benefits and substantial resource savings. Further trials are needed to validate these findings and assess patient preferences and cost-effectiveness.
METHODS: In this multicenter, open-label trial, 150 patients were randomized 1:1 to either i-HDF (n = 77) or c-HDF (n = 73), regardless of comorbidity burden. The primary outcome was the decline in glomerular filtration rate (GFR) over 12 months. Secondary outcomes included changes in RKF (measured by 24-hour urine output, KrU, and creatinine clearance [KrCr]), incidence of anuria, hospital admissions, mortality, quality of life (using the Kidney Disease Quality of Life-36), and the total number of HDF sessions.
RESULTS: No significant differences were found between groups in GFR decline, RKF parameters, or clinical outcomes such as hospitalizations, mortality, or anuria (5 cases in i-HDF vs. 4 in c-HDF). At 6 months, the i-HDF group reported slight improvements in quality of life, particularly in disease burden domains, though these gains diminished by 12 months. Fifteen patients in the i-HDF group transitioned to thrice-weekly HDF after an average of 193 days, and none refused the increase in frequency when indicated. The i-HDF group received significantly fewer dialysis sessions annually (69.1 vs. 122.6).
CONCLUSION: Incremental HDF is a safe and effective option for patients with preserved RKF, offering similar clinical outcomes to conventional schedules, with modest short-term quality-of-life benefits and substantial resource savings. Further trials are needed to validate these findings and assess patient preferences and cost-effectiveness.