On-line hemodiafiltration in the large RISCAVID study

Despite significant advances in hemodialysis (HD) and medical therapy, mortality rates in patients with chronic kidney disease stage 5 (CKD-5D) remain unacceptably high, with cardiovascular (CV) mortality risk in dialysis patients being several times higher than that of a general population. The CV mortality risk of a 25-to 34-year-old dialysis patient is approximately the same as the one of an otherwise healthy person aged over 85 in the general population. HD patients are not only exposed to the various traditional risk factors valid for the general population but in addition also to the non-traditional risk factors resulting either from uremia per se or from the dialysis treatment. Our understanding of chronic inflammation in CKD-5D and of its influence in the accelerated atherosclerotic process has greatly evolved. Dialysis therapy, performed efficiently, has the potential to provide CKD-5D patients with benefits beyond the life-saving function of removal accumulated waste products and excess fluid. There is sufficient evidence to indicate that on-line hemodiafiltration has the potential to improve chronic inflammation, fluid overload, left ventricular hypertrophy, anemia and quality of life of CKD-5D patients. In the search for more effective, safer and less expensive approaches to the management of the above conditions, an innovative concept of biocompatibility should be broadened to the HD system/patient evaluation. Here, we intend to present new insights obtained from a prospective observational study (RISCAVID, 'RISchio CArdiovascolare nei pazienti afferenti all'Area Vasta In Dialisi') performed on a large HD population in the northwestern region of Tuscany, Italy, on the assessment of the different parameters of chronic inflammation and gross/CV mortality and anemia management.