title: Nocturnal, every-other-day, online haemodiafiltration: an effective therapeutic alternative.
abstract: BACKGROUND
  Longer and more frequent dialysis sessions have demonstrated excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. The aim of this study was to evaluate the beneficial effects of a longer (nocturnal) and more frequent (every-other-day) dialysis schedule with OL-HDF at the same or the highest convective volume.
  
  
  METHODS
  This prospective, in-centre crossover study was carried out in 26 patients, 18 males and 8 females, 49.2±14 years old, on 4-5 h thrice-weekly post-dilution OL-HDF, switched to nocturnal every-other-day OL-HDF. Patient inclusion criteria consisted of stable patients with good vascular access and with good prospects for improved occupational, psychological and social rehabilitation. Patients were randomly assigned into two groups: Group A received the same convective volume as previously for 6 months followed by a higher convective volume for a further 6 months, while Group B received the same schedule in reverse order.
  
  
  RESULTS
  Nocturnal every-other-day OL-HDF was well tolerated and 56% of patients who were working during the baseline period continued to work throughout the study with practically no absenteeism. The convective volume was 26.7±2 L at baseline, 27.5±2 with the unchanged volume and 42.9±4 L with the higher volume. eKt/V increased from 1.75±0.4 to 3.37±0.9. Bicarbonate, blood urea nitrogen (BUN) and creatinine values decreased, while phosphate levels fell markedly with a 90% reduction in phosphate binders. Blood pressure and left ventricular hypertrophy (LVH) improved and the use of anti-hypertensive drugs decreased. In both groups, BUN, creatinine and β2-microglobulin reduction ratios improved. Different removal patterns were observed for myoglobin, prolactin and α1-acid glycoprotein.
  
  
  CONCLUSIONS
  Nocturnal every-other-day OL-HDF could be an excellent therapeutic alternative since good tolerance and occupational rehabilitation, marked improvement in dialysis dose, nutritional status, LVH, phosphate and hypertension control and a substantial reduction in drug requirements were observed. In this crossover study, different removal patterns of large solutes were identified.
authors.affiliation: Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain. fmaduell@clinic.ub.es
authors.forename: Francisco
authors.initials: F
authors.lastname: Maduell
authors.forename: Marta
authors.initials: M
authors.lastname: Arias
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Durán
authors.forename: Manel
authors.initials: M
authors.lastname: Vera
authors.forename: Néstor
authors.initials: N
authors.lastname: Fontseré
authors.forename: Manel
authors.initials: M
authors.lastname: Azqueta
authors.forename: Nayra
authors.initials: N
authors.lastname: Rico
authors.forename: Nuria
authors.initials: N
authors.lastname: Pérez
authors.forename: Alexis
authors.initials: A
authors.lastname: Sentis
authors.forename: Montserrat
authors.initials: M
authors.lastname: Elena
authors.forename: Néstor
authors.initials: N
authors.lastname: Rodriguez
authors.forename: Carola
authors.initials: C
authors.lastname: Arcal
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bergadá
authors.forename: Aleix
authors.initials: A
authors.lastname: Cases
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Bedini
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001794:Blood Pressure; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000517:prevention & control*; D007674:Kidney Diseases / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D015415:Biomarkers