title: A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration.
abstract: BACKGROUND
  The choice between hemodiafiltration (HDF) or high-flux hemodialysis (HD) to treat end-stage kidney disease remains a matter of debate. The duration of recovery time after treatment has been associated with mortality, affects quality of life, and may therefore be important in informing patient choice. We aimed to establish whether recovery time is influenced by treatment with HDF or HD.
  
  
  METHODS
  Randomized patient-blinded crossover trial.
  
  
  METHODS
  100 patients with end-stage kidney disease were enrolled from 2 satellite dialysis units in Glasgow, United Kingdom.
  
  
  METHODS
  8 weeks of HD followed by 8 weeks of online postdilution HDF or vice versa.
  
  
  RESULTS
  Posttreatment recovery time, symptomatic hypotension events, dialysis circuit clotting events, and biochemical parameters.
  
  
  METHODS
  Patient-reported recovery time in minutes, incidence of adverse events during treatments, hematology and biochemistry results, quality-of-life questionnaire.
  
  
  RESULTS
  There was no overall difference in recovery time between treatments (medians for HDF vs HD of 47.5 [IQR, 0-240] vs 30 [IQR, 0-210] minutes, respectively; P=0.9). During HDF treatment, there were significant increases in rates of symptomatic hypotension (8.0% in HDF vs 5.3% in HD; relative risk [RR], 1.52; 95% CI, 1.2-1.9; P<0.001) and intradialytic tendency to clotting (1.8% in HDF vs 0.7% in HD; RR, 2.7; 95% CI, 1.5-5.0; P=0.002). Serum albumin level was significantly lower during HDF (3.2 vs 3.3g/dL; P<0.001). Health-related quality-of-life scores were equivalent.
  
  
  CONCLUSIONS
  Single center; mean achieved HDF convection volume, 20.6L.
  
  
  CONCLUSIONS
  Patients blinded to whether they were receiving HD or HDF in a randomized controlled crossover study reported similar posttreatment recovery times and health-related quality-of-life scores.
authors.affiliation: Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom; Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland, United Kingdom. Electronic address: jsmith82@nhs.net.
authors.forename: James R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom.
authors.forename: Norica
authors.initials: N
authors.lastname: Zimmer
authors.affiliation: Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bell
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Francq
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Mactier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001622:Betaine / Q000097:blood; D018592:Cross-Over Studies; D005260:Female; D006304:Health Status; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011188:Potassium / Q000097:blood; D011788:Quality of Life; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D016037:Single-Blind Method; D013997:Time Factors; D006113:United Kingdom; D014508:Urea / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D010281:Parathyroid Hormone; D010710:Phosphates; D001613:beta 2-Microglobulin; D001622:Betaine; D014508:Urea; D014805:Vitamin B 12; D011188:Potassium
keywords: Hemodialysis (HD); blood pressure; dialysis circuit clotting; dialysis modality; end-stage kidney disease (ESKD); hemodiafiltration (HDF); high-flux HD; intradialytic hypotension; quality of life; randomized controlled trial (RCT); recovery time; symptomatic hypotension