title: Haemodiafiltration does not reduce the frequency of intradialytic hypotensive episodes when compared to cooled high-flux haemodialysis.
abstract: BACKGROUND
  Intradialytic hypotension remains the commonest complication of outpatient haemodialysis (HD) treatments. On-line haemodiafiltration (HDF) has been reported to reduce the frequency of intradialytic hypotension. We introduced on-line HDF into our satellite dialysis program, and prospectively audited the effect of HDF on cardiovascular stability.
  
  
  METHODS
  34 patients' dialysis schedules (Tuesday/Thursday/Saturday) were converted to online post-dilutional HDF, and 44 patients' dialysis schedules (Monday/Wednesday/Friday) remained on high-flux HD. Blood pressure and intra-treatment complications were monitored prospectively for 12 months.
  
  
  RESULTS
  There was no significant change in pre-treatment mean arterial blood pressure in the HDF group during the 12 months of the study (pre-treatment 113.7 ± 0.7 mm Hg vs. 109.3 ± 2.8 after 12 months), or for the HD cohort (113.9 ± 2.7 vs. 117.9 ± 2.6). However, the frequency of intradialytic hypotensive episodes was greater for the HDF cohort: 25.9 versus 16.5% in the HD cohort, p = 0.0116. During HDF, on average >16 litres of substitution fluid was used and the median temperature was 36°C (35°C-36°C), higher than the dialysate in the HD cohort which was 35°C (35°C-36°C), p < 0.05.
  
  
  CONCLUSIONS
  In this study, HDF did not improve blood pressure control or reduce the frequency of intradialytic hypotensive episodes compared to high-flux HD using cooled dialysate.
authors.affiliation: Center for Nephrology, Royal Free Hospital, University College London, Medical School, Royal Free Campus, London, UK.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Pinney
authors.forename: Thomas
authors.initials: T
authors.lastname: Oates
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure; D003080:Cold Temperature; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods*; D012964:Sodium / Q000097:blood
chemical_list: D012964:Sodium