title: Online-haemodiafiltration vs. conventional haemodialysis: a cross-over study.
abstract: BACKGROUND
  The main short-term advantages of haemodiafiltration (HDF) are supposedly better removal of Beta2-microglobulin (ß2-m) and phosphate, and better haemodynamic stability. The main disadvantage is higher costs. The aim of the study was to compare the clinical and biological parameters associated with HDF and high-flux haemodialysis (HD), using a cross-over design, while maintaining the same dialysis parameters.
  
  
  METHODS
  All patients on a 3 × 4 hours schedule were observed during 3 identical 6-months periods: HDF1 - HD - HDF2. The mean values for the 2 last months of each period were compared.
  
  
  RESULTS
  A total of 51 patients (76 % males, 45 % diabetic) with a mean age of 74 ± 15 years, and who had been on dialysis for 49 ± 60 months were included. The mean blood flow (329 ± 27 ml/min), dialysate flow (500 ml/min), and convection volumes (21.6 ± 3.2 L) were recorded. Patient medications were not changed. Predialysis blood pressure, phosphataemia, calcaemia, iPTH, Kt/V, nPNA and intradialytic events were similar throughout the 3 periods. Only serum albumin (34. 4 ± 3.6, 35.9 ± 3.4, 34.1 ± 4 g/L, p < 0. 0001) and ß2-m serum levels (26.1 ± 5.4, 28 ± 6, 26.5 ± 5 mg/L, p < 0.001, values shown for HDF1, HD, HDF2, respectively) were significantly lower during the HDF periods. Factor associated with higher delta serum albumin levels between HD and HDF periods was mainly a lower convection volume.
  
  
  CONCLUSIONS
  Comparing HDF and HD, we did not observe any differences in haemodynamic stability or in serum phosphate levels. Only serum ß2-m (-6% vs. HD) and albumin (-5% vs. HD) levels changed. The long-term clinical consequences of these biochemical differences should be prospectively assessed.
authors.affiliation: NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France. guillaume-jean-crat@wanadoo.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.affiliation: NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France. jean-marc.hurot@fmc-ag.com.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Hurot
authors.affiliation: NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France. patrik.deleaval@fmc-ag.com.
authors.forename: Patrik
authors.initials: P
authors.lastname: Deleaval
authors.affiliation: NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France. brice.mayor@fmc-ag.com.
authors.forename: Brice
authors.initials: B
authors.lastname: Mayor
authors.affiliation: NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France. Christie.lorriaux@fmc-ag.com.
authors.forename: Christie
authors.initials: C
authors.lastname: Lorriaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000191:economics / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000378:metabolism*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism*; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000378:metabolism*
chemical_list: D010710:Phosphates; D012709:Serum Albumin; D001613:beta 2-Microglobulin