Eight-Year Experience with Nocturnal, Every-Other-Day, Online Haemodiafiltration.
BACKGROUND
New haemodialysis therapeutic regimens are required to improve patient survival. Longer and more frequent dialysis sessions have produced excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment.


METHODS
In this single-centre observational study, 57 patients on 4-5-hour thrice-weekly OL-HDF were switched to nocturnal every-other-day OL-HDF. Inclusion criteria consisted of stable patients with good prospects for improved occupational, psychological and social rehabilitation. The aim of this study was to report our 8-year experience with this schedule and to evaluate analytical and clinical outcomes.


RESULTS
Nocturnal, every-other-day OL-HDF was well tolerated and 56% of patients were working. The convective volume increased from 26.7 ± 2 litres at baseline to 46.6 ± 6.5 litres at 24 months (p < 0.01). Increasing the dialysis dose significantly decreased bicarbonate, blood-urea-nitrogen and creatinine values. Predialysis phosphate levels fell markedly with complete suspension of phosphate binders from the second year of follow-up. Although haemoglobin was unchanged, there was a 50.4% reduction in darbepoetin dose at 24 months and a significant decrease in the erythropoietin resistance index. Blood pressure significantly decreased in a few months. Antihypertensive medication requirements were decreased by 60% after 3 months and by 73% after 1 year and this difference was maintained thereafter.


CONCLUSIONS
Nocturnal, every-other-day OL-HDF could be an excellent therapeutic alternative since it is well tolerated and leads to clinical and social-occupational rehabilitation with satisfactory morbidity and mortality. These encouraging results strengthen us to continue and invite other clinicians to join this initiative.
Department of Nephrology, Hospital Clx00ED;nic Barcelona, Barcelona, Spain.
Francisco
F
Maduell
Raquel
R
Ojeda
Marta
M
Arias-Guillen
Florencia
F
Rossi
Néstor
N
Fontseré
Manel
M
Vera
Nayra
N
Rico
Leonardo Nicolás
LN
Gonzalez
Gastón
G
Piñeiro
Mario
M
Jiménez-Hernández
Lida
L
Rodas
José Luis
JL
Bedini
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001842:Bone and Bones / Q000737:chemistry; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010865:Pilot Projects; D055815:Young Adult