title: Haemodiafiltration versus high-flux haemodialysis: Effects on phosphate control and erythropoietin response.
abstract: BACKGROUND
  Haemodiafiltration (HDF) has been reported to improve erythropoietin (EPO) responsiveness and phosphate clearance. We prospectively audited the effect of HDF on EPO dosages, weight and serum phosphate.
  
  
  METHODS
  34 patients dialyzing on Tu/Th/Sa switched to HDF, and 44 dialyzing on M/W/F remained on high-flux haemodialysis (HD) and were followed for 12 months.
  
  
  RESULTS
  Dialysis adequacy (Kt/V start HDF 1.56 ± 0.03 vs. HD 1.58 ± 0.04 and 12 months 1.55 ± 0.03 vs. 1.59 ± 0.03), haemoglobin (start 11.7 ± 0.3 vs. 11,8 ± 0.2 g/dl and end 11.5 ± 0.1 vs. 11.3 ± 0.3 g/dl), weight (start 69.8 ± 2.4 vs. 67.8 ± 2.5 kg and end 67.4 ± 2.5 vs. 66.1 ± 2.3 kg), or EPO prescription (start 83 (61-186) vs. 123 (71-225) IU/kg/weeks and 12 months 142 (48-188) vs. 124 (59-223) IU/kg/weeks) did not differ. There were no differences in serum albumin, CRP, calcium and parathyroid hormone. Serum beta-2-microglobulin (B₂M) decreased with HDF (32.7 ± 1.9 vs. 28.1 ± 1.1 mg/l, p < 0.01), but not with HD (31.6 ± 1.4 vs. 31.5 ± 1.1 mg/l). Serum phosphate fell with HDF (start 1.48 ± 0.08 vs. 1.57 ± 0.07 mmol/l (p = NS); 3 months 1.35 ± 0.07 vs. 1.61 ± 0.08; 6 months 1.34 ± 0.06 vs. 1.57 ± 0.06, and 12 months 1.36 ± 0.07 vs. 1.67 ± 0.07, all p < 0.05).
  
  
  CONCLUSIONS
  HDF did not lead to weight gain or improved EPO responsiveness in this prospective observational study. However, predialysis serum phosphate and B₂M fell with HDF.
authors.affiliation: Center for Nephrology, Royal Free Hospital, University College London Medical School, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Oates
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Pinney
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004921:Erythropoietin / Q000378:metabolism*; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood / Q000378:metabolism*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D010710:Phosphates; D004921:Erythropoietin