Acetate-free biofiltration reduces intradialytic hypotension: a European multicenter randomized controlled trial

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Dialysis Therapy

Background:

• Intradialytic hypotension (IH) is a frequent complication of bicarbonate hemodialysis (BD).
• IH contributes to dialysis intolerance and high cardiovascular risks in dialysis patients.
• Convective therapies may mitigate these risks.

Purpose of the Study:

• To compare long-term intradialytic hypotension (IH) rates between acetate-free biofiltration (AFB) and bicarbonate hemodialysis (BD).
• To assess the influence of AFB versus BD on predialysis systolic blood pressure (SBP).
• To evaluate the long-term effects of AFB and BD on cardiovascular morbidity and mortality.

Main Methods:

• Analysis of data from a randomized controlled trial with 371 new-to-dialysis patients.
• Patients were randomized to either bicarbonate hemodialysis (BD) (n=194) or acetate-free biofiltration (AFB) (n=177).
• A 3-year follow-up period was utilized to assess outcomes.

Main Results:

• Acetate-free biofiltration (AFB) demonstrated a significantly lower risk of intradialytic hypotension (IH) (incidence rate ratio 0.60, p < 0.0001).
• Systolic blood pressure (SBP) decreased in the AFB group (p = 0.01), whereas no significant change was observed in the BD group.
• Cardiovascular morbidity and mortality rates were comparable between the AFB and BD treatment groups.

Conclusions:

• Acetate-free biofiltration (AFB) is associated with a lower long-term rate of intradialytic hypotension (IH) compared to bicarbonate hemodialysis (BD).
• AFB effectively reduces predialysis systolic blood pressure (SBP) in new-to-dialysis patients.
• AFB offers a potential alternative for improving intradialytic stability without adversely affecting long-term cardiovascular outcomes.