Comparison between hemofiltration and hemodiafiltration in a long-term prospective cross-over study.
BACKGROUND
The objective of the study was to compare the convective treatment modes, on-line hemofiltration (HF) and on-line hemodiafiltration (HDF), regarding cardiovascular tolerance and effects on blood pressure, when applied under similar conditions in stable dialysis patients.


METHODS
39 clinically stable dialysis patients were treated with HD for 6 months (run-in period), followed by HF and HDF in random order for 2x6 months. Similar biocompatibility (same membrane and fluid quality), similar treatment time and urea Kt/V were achieved using AK100/200 ULTRA machines, polyamide membranes in low-flux and high-flux versions and appropriate adjustment of blood flow rate (Qb) and dilution ratio (Qb/Qinf). Predilution was used for HDF (target dilution ratio = 2/1 ) as well as for HF (target dilution ratio = 1/1).


RESULTS
30 patients completed the study; 5 dropped out for non-study related reasons and 4 for non-compliance. Treatment with HF in comparison to HDF showed fewer hypotension episodes during the sessions per patient and month (HF: 0.5, HDF 1.1; p = 0.017), less plasma expander administration per patient and month (HF: 35.9 ml, HDF: 103.1 ml; p = 0.035), fewer episodes of intra-session headache (HF: 0.1, HDF: 0.4; p = 0.06), and higher pre-session MAP (HF: 98.4 mmHg, HDF: 93.8 mmHg; p = 0.037). No significant difference was found in inter-treatment weight gain, post-session MAP, or pre-session plasma sodium.


CONCLUSIONS
HF and HDF provide good control of intra-session symptoms and blood pressure in stable patients. Treatment with HF resulted in a significant reduction in intra-session hypotension and a slight but significant increase in pre-session MAP, caused by an increase in systolic BP without any effect on the prevalence of hypertension or the dose of antihypertensive drugs, all compared to HDF.
Altieri
Paolo
P
Department of Renal Diseases, G. Brotzu Hospital, Cagliari, Italy. paaltie@tin.it
Sorba
Gianbattista
G
Bolasco
Piergiorgio
P
Ledebo
Ingrid
I
Ganadu
Marino
M
Ferrara
Rocco
R
Menneas
Amalia
A
Asproni
Emilio
E
Casu
Domenica
D
Passaghe
Mario
M
Sau
Giovanna
G
Cadinu
Franco
F
D001794:Blood Pressure; D018592:Cross-Over Studies; D017097:Electric Impedance; D005260:Female; D017583:Hemodiafiltration; D006440:Hemofiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged