A comparison of on-line hemodiafiltration and high-flux hemodialysis: a prospective clinical study.
Some of the morbidity associated with chronic hemodialysis is thought to result from retention of large molecular weight solutes that are poorly removed by diffusion in conventional hemodialysis. Hemodiafiltration combines convective and diffusive solute removal in a single therapy. The hypothesis that hemodiafiltration provides better solute removal than high-flux hemodialysis was tested in a prospective, randomized clinical trial. Patients were randomized to either on-line postdilution hemodiafiltration or high-flux hemodialysis. The groups did not differ in body size, treatment time, blood flow rate, or net fluid removal. The filtration volume in hemodiafiltration was 21 +/-1 L. Therapy prescriptions were unchanged for a 12-mo study period. Removal of both small (urea and creatinine) and large (ss(2)-microglobulin and complement factor D) solutes was significantly greater for hemodiafiltration than for high-flux hemodialysis. The increased urea and creatinine removal did not result in lower pretreatment serum concentrations in the hemodiafiltration group. Pretreatment plasma beta(2)-microglobulin concentrations decreased with time (P< 0.001); however, the decrease was similar for both therapies (P = 0.317). Pretreatment plasma complement factor D concentrations also decreased with time (P<0.001), and the decrease was significantly greater with hemodiafiltration than with high-flux hemodialysis (P = 0.010). The conclusion is that on-line hemodiafiltration provides superior solute removal to high-flux hemodialysis over a wide molecular weight range. The improved removal may not result in lower pretreatment plasma concentrations, however, possibly because of limitations in mass transfer rates within the body.
Ward
Richard A
RA
Department of Medicine, University of Louisville, Louisville, Kentucky.
Schmidt
Bärbel
B
Department of Medicine I, Klinikum Grosshadern, University of Munich, Munich.
Hullin
Jeannine
J
Department of Medicine I, Klinikum Grosshadern, University of Munich, Munich.
Hillebrand
Günther F
GF
Department of Medicine I, Klinikum Grosshadern, University of Munich, Munich.|Kuratorium fuer Dialyse und Nierentransplantation, Neuried, Germany.
Samtleben
Walter
W
Department of Medicine I, Klinikum Grosshadern, University of Munich, Munich.|Kuratorium fuer Dialyse und Nierentransplantation, Neuried, Germany.
D000740:Anemia / Q000097:blood / Q000188:drug therapy; D011416:Complement Factor D / Q000032:analysis; D003404:Creatinine / Q000097:blood; D004573:Electrolytes / Q000097:blood; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D017583:Hemodiafiltration / Q000592:standards*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards*; D013813:Therapy, Computer-Assisted; D014508:Urea / Q000097:blood; D001613:beta 2-Microglobulin / Q000097:blood
D004573:Electrolytes; D001613:beta 2-Microglobulin; D004921:Erythropoietin; D014508:Urea; D003404:Creatinine; C493488:CFD protein, human; D011416:Complement Factor D