title: Survival Benefit of Hemodiafiltration Compared With Prolonged High-flux Hemodialysis.
abstract: BACKGROUND
  Patients on dialysis have a high rate of death, mainly of cardiovascular cause. Nephrologists are actively looking for ways to improve patients' outcomes, and alternative dialysis strategies, such as long conventional hemodialysis and hemodiafiltration, are currently being investigated. The aim of this study was to compare anemia, nutrition, inflammation, mineral metabolism, and 3-year survival rates between patients treated with hemodiafiltration and prolonged high-flux hemodialysis (HFH).
  
  
  METHODS
  A total of 58 dialysis patients were divided into 2 groups to undergo hemodiafiltration 3 times weekly, 12 hours in total per week, or prolonged duration of HFH (≥ 15 h/w). One-year biochemical parameters were collected retrospectively, together with 36 months patients' survival (prospectively).
  
  
  RESULTS
  Patients in the HFH group had longer dialysis vintage; significantly higher levels of hemoglobin (despite less frequent use of erythropoietin-stimulating agents), serum albumin, serum calcium, and serum bicarbonate; and a lower in-tact parathyroid hormone level. Survival rates were comparable between the two groups. The Cox proportional hazard model showed that patients treated with longer HFH had a 32% relative risk reduction of mortality compared to patients treated with hemodiafiltration, but without statistical significance (hazard ratio, 0.68; 95% confidence interval, 0.21 to 2.20; adjusted for diabetes mellitus).
  
  
  CONCLUSIONS
  Longer duration of hemodialysis with high-flux membranes had beneficial effects on anemia indexes, mineral metabolism, nutrition parameters, and acidosis in comparison with hemodiafiltration. However, hemodiafiltration did not offer a 36-months survival benefit over prolonged HFH.
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Belgrade, Serbia. djuricmed@gmail.com.
authors.forename: Petar S
authors.initials: PS
authors.lastname: Djuric
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Jankovic
authors.forename: Jovan
authors.initials: J
authors.lastname: Popovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Tosic Dragovic
authors.forename: Ana
authors.initials: A
authors.lastname: Bulatovic
authors.forename: Zivka
authors.initials: Z
authors.lastname: Djuric
authors.forename: Milos
authors.initials: M
authors.lastname: Mitrovic
authors.forename: Nada
authors.initials: N
authors.lastname: Dimkovic
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology; D001639:Bicarbonates / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D017583:Hemodiafiltration / Q000379:methods*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010281:Parathyroid Hormone / Q000378:metabolism; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors
chemical_list: D001639:Bicarbonates; D006397:Hematinics; D006454:Hemoglobins; D010281:Parathyroid Hormone; D012709:Serum Albumin; D004921:Erythropoietin; D002118:Calcium