Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly.
Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30-day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux hemodialysis and online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a statistical unit according to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of metabolic bone disease biomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux hemodialysis in the elderly.
Laboratoire de Biochimie, CHU de Montpellier, Montpellier, France; Institut de Recherche et de Formation en Dialyse, Montpellier, France; PhyMedExp, INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France.
Marion
M
Morena
Département de l'Information Médicale, CHU de Montpellier, Montpellier, France.
Audrey
A
Jaussent
Association pour l'Installation à Domicile des Epurations Rénales (AIDER), Montpellier, France.
Lotfi
L
Chalabi
Service de Néphrologie, CHU de Montpellier, Montpellier, France.
Hélène
H
Leray-Moragues
Service de Néphrologie, CHU de Montpellier, Montpellier, France.
Leila
L
Chenine
ATS, Saint-Denis, France.
Alain
A
Debure
Service de Néphrologie, CHU de Saint Etienne, Saint-Etienne, France.
Damien
D
Thibaudin
Association Régionale pour le Traitement de l'Insuffisance Rénale Chronique, Saint-Priest-en-Jarez, France.
Lynda
L
Azzouz
AIDER, Nîmes, France.
Laure
L
Patrier
Centre Hémodialyse du Lez, Castelnau le Lez, France.
Francois
F
Maurice
Centre de Néphrologie du Mont Blanc, Sallanches, France.
Philippe
P
Nicoud
Polyclinique Saint Martin, Pessac, France.
Claude
C
Durand
Service de Néphrologie, CHU de Toulouse, Toulouse, France.
Bruno
B
Seigneuric
Laboratoire de Biochimie, CHU de Montpellier, Montpellier, France.
Anne-Marie
AM
Dupuy
Département de l'Information Médicale, CHU de Montpellier, Montpellier, France.
Marie-Christine
MC
Picot
Laboratoire de Biochimie, CHU de Montpellier, Montpellier, France; Institut de Recherche et de Formation en Dialyse, Montpellier, France; PhyMedExp, INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France. Electronic address: jp-cristol@chu-montpellier.fr.
Jean-Paul
JP
Cristol
Institut de Recherche et de Formation en Dialyse, Montpellier, France; Université de Montpellier, Néphrologie, Montpellier, France.
Bernard
B
Canaud
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D015577:Geriatric Assessment; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
cardiovascular risk biomarkers; chronic kidney disease; hemodiafiltration; intradialytic tolerance; mortality; safety