Long-term online hemodiafiltration does not reduce the frequency and severity of acquired cystic kidney disease in hemodialysis patients.
BACKGROUND
Acquired cystic kidney disease (ACKD) is a frequent complication in chronic hemodialysis (HD) patients and a risk factor for renal cell carcinoma. Online hemodiafiltration (HDF) provides better clearance of middle molecular weight solutes, but its effect on ACKD has not been investigated.


METHODS
This case-control study enrolled 86 patients (43 HDF patients and 43 HD patients) who were matched according to age, sex, and duration of renal replacement therapy. The mean duration of HDF was 63 (+/- 35) months. The frequency and severity of ACKD was evaluated by ultrasonography using a severity scoring system.


RESULTS
We observed ACKD in 23 of the HD patients (53.5%) and 21 of the HDF patients (48.8%). This difference was not statistically significant (p = 0.829). The overall ACKD severity scores were similar in the two groups (p = 0.875). Patients on HDF had significantly lower serum levels of alkaline phosphatase and intact parathyroid hormone. Multiple logistic regression analysis indicated that duration of renal replacement therapy was the only risk factor for the presence of ACKD (p < 0.001). There was a significant correlation between duration of renal replacement therapy and ACKD severity score (r = 0.589, p < 0.001).


CONCLUSIONS
Our results suggest that long-term online HDF does not reduce the frequency and severity of ACKD in dialysis patients. Duration of renal replacement therapy is the most important risk factor for ACKD. Factors that cannot be corrected by use of HDF may contribute to the formation of renal cysts.
Department of Nephrology and Kidney Research Center, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Chih-Jen
CJ
Weng
Ming-Yang
MY
Chang
Yung-Cheng
YC
Chen
Ya-Chung
YC
Tian
Ji-Tseng
JT
Fang
Chih-Wei
CW
Yang
D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D052177:Kidney Diseases, Cystic / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D007677:Kidney Function Tests; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009862:Online Systems; D011336:Probability; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016896:Treatment Outcome