Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD.
Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. In this multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n = 70), online predilution hemofiltration (HF; n = 36), or online predilution hemodiafiltration (HDF; n = 40). The primary end point was the frequency of intradialytic symptomatic hypotension (ISH). Compared with the run-in period, the frequency of sessions with ISH during the evaluation period increased for HD (7.1 to 7.9%) and decreased for both HF (9.8 to 8.0%) and HDF (10.6 to 5.2%) (P < 0.001). Mean predialysis systolic BP increased by 4.2 mmHg among those who were assigned to HDF compared with decreases of 0.6 and 1.8 mmHg among those who were assigned to HD and HF, respectively (P = 0.038). Multivariate logistic regression demonstrated significant risk reductions in ISH for both HF (odds ratio 0.69; 95% confidence interval 0.51 to 0.92) and HDF (odds ratio 0.46, 95% confidence interval 0.33 to 0.63). There was a trend toward higher dropout for those who were assigned to HF (P = 0.107). In conclusion, compared with conventional HD, convective therapies (HDF and HF) reduce ISH in long-term dialysis patients.
Locatelli
Francesco
F
Department of Nephrology and Dialysis, Ospedale Alessandro Manzoni, Lecco, Italy. f.locatelli@ospedale.lecco.it
Altieri
Paolo
P
Andrulli
Simeone
S
Bolasco
Piergiorgio
P
Sau
Giovanna
G
Pedrini
Luciano A
LA
Basile
Carlo
C
David
Salvatore
S
Feriani
Mariano
M
Montagna
Giovanni
G
Di Iorio
Biagio Raffaele
BR
Memoli
Bruno
B
Cravero
Raffaella
R
Battaglia
Giovanni
G
Zoccali
Carmine
C
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts
D000959:Antihypertensive Agents
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