title: Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD.
abstract: 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.
authors.affiliation: Department of Nephrology and Dialysis, Ospedale Alessandro Manzoni, Lecco, Italy. f.locatelli@ospedale.lecco.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Altieri
authors.forename: Simeone
authors.initials: S
authors.lastname: Andrulli
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Bolasco
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sau
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Pedrini
authors.forename: Carlo
authors.initials: C
authors.lastname: Basile
authors.forename: Salvatore
authors.initials: S
authors.lastname: David
authors.forename: Mariano
authors.initials: M
authors.lastname: Feriani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montagna
authors.forename: Biagio Raffaele
authors.initials: BR
authors.lastname: Di Iorio
authors.forename: Bruno
authors.initials: B
authors.lastname: Memoli
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cravero
authors.forename: Giovanni
authors.initials: G
authors.lastname: Battaglia
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents
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