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Comparison between hemofiltration and hemodiafiltration in a long-term prospective cross-over study
Paolo Altieri1, Gianbattista Sorba, Piergiorgio Bolasco
1Department of Renal Diseases, G. Brotzu Hospital, Cagliari, Italy. paaltie@tin.it
Journal of Nephrology
|September 15, 2004
Summary
On-line hemofiltration (HF) offers better cardiovascular tolerance than on-line hemodiafiltration (HDF) in dialysis patients. HF significantly reduced hypotension episodes and increased pre-session mean arterial pressure compared to HDF.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Cardiovascular Physiology
Background:
- Dialysis patients experience cardiovascular challenges during treatment.
- Convective treatments like hemofiltration (HF) and hemodiafiltration (HDF) are used to improve patient outcomes.
- Comparing HF and HDF under similar conditions is crucial for understanding their cardiovascular effects.
Purpose of the Study:
- To compare the cardiovascular tolerance of on-line hemofiltration (HF) versus on-line hemodiafiltration (HDF).
- To evaluate the effects of HF and HDF on blood pressure in stable dialysis patients.
- To assess intra-session symptoms and hemodynamic stability during convective treatments.
Main Methods:
- 39 stable dialysis patients underwent 6 months of hemodialysis (HD) followed by 6 months each of randomized HF and HDF.
- Treatments were standardized for biocompatibility, duration, and urea Kt/V using specific dialysis machines and membranes.
- Predilution was employed for both HF (ratio 1:1) and HDF (ratio 2:1), with adjusted blood flow rates.
Main Results:
- On-line hemofiltration (HF) showed significantly fewer hypotension episodes (0.5/patient/month) compared to on-line hemodiafiltration (HDF) (1.1/patient/month).
- HF treatment resulted in less plasma expander use (35.9 ml/patient/month vs. 103.1 ml/patient/month) and fewer headaches than HDF.
- Patients on HF exhibited a higher pre-session mean arterial pressure (98.4 mmHg vs. 93.8 mmHg) compared to those on HDF.
Conclusions:
- Both on-line hemofiltration (HF) and on-line hemodiafiltration (HDF) effectively manage intra-session symptoms and blood pressure in stable dialysis patients.
- HF demonstrates superior cardiovascular tolerance, evidenced by a significant reduction in hypotension and an increase in pre-session mean arterial pressure compared to HDF.
- HF treatment improved systolic blood pressure without impacting hypertension prevalence or antihypertensive medication dosage.