Influence of Hemofiltration on Intradialytic Plasma Volume Decrease.

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Technology

Background:

• Intradialytic hypotension is a common complication during hemodialysis (HD).
• Intradialytic plasma volume decrease (IPVD) is a primary cause of intradialytic hypotension.
• Hemofiltration may potentially mitigate IPVD, but its effect in online hemodiafiltration (ol-HDF) needs clarification.

Purpose of the Study:

• To investigate whether online hemodiafiltration (ol-HDF), in both pre-dilution and post-dilution modes, prevents intradialytic plasma volume decrease (IPVD) compared to conventional hemodialysis (HD).

Main Methods:

• A crossover study involving 22 patients undergoing maintenance dialysis.
• Comparison of IPVD in pre-ol-HDF, post-ol-HDF, and HD using intradialytic changes in hematocrit.
• Calculation of IPVD relative to intradialytic body weight loss (IBWL/BW).

Main Results:

• While ol-HDF showed smaller intradialytic body weight loss ratios, it did not significantly reduce IPVD levels compared to HD.
• The IPVD levels were not statistically different between pre-ol-HDF (0.108 ± 0.058), post-ol-HDF (0.113 ± 0.053), and HD (0.101 ± 0.057).
• Similarly, IPVD/IBWL/BW ratios did not show significant differences across the modalities (P = 0.21).

Conclusions:

• Online hemodiafiltration, irrespective of pre- or post-dilution mode, does not offer a preventive effect on intradialytic plasma volume decrease when compared to standard hemodialysis.
• These findings suggest that ol-HDF may not be superior to HD in managing fluid shifts that lead to intradialytic hypotension.