Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD

Abstract

Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. In this multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n = 70), online predilution hemofiltration (HF; n = 36), or online predilution hemodiafiltration (HDF; n = 40). The primary end point was the frequency of intradialytic symptomatic hypotension (ISH). Compared with the run-in period, the frequency of sessions with ISH during the evaluation period increased for HD (7.1 to 7.9%) and decreased for both HF (9.8 to 8.0%) and HDF (10.6 to 5.2%) (P < 0.001). Mean predialysis systolic BP increased by 4.2 mmHg among those who were assigned to HDF compared with decreases of 0.6 and 1.8 mmHg among those who were assigned to HD and HF, respectively (P = 0.038). Multivariate logistic regression demonstrated significant risk reductions in ISH for both HF (odds ratio 0.69; 95% confidence interval 0.51 to 0.92) and HDF (odds ratio 0.46, 95% confidence interval 0.33 to 0.63). There was a trend toward higher dropout for those who were assigned to HF (P = 0.107). In conclusion, compared with conventional HD, convective therapies (HDF and HF) reduce ISH in long-term dialysis patients.

Figures

Figure 1.

More patients shift out of HF than other treatment modalities. Survival function in pre-HF group was lower (85% at 1-year follow-up) as compared with the other groups (96% at 1-year follow-up). P = 0.054, log rank test.

Figure 2.

7.5% of all of the 28,950 sessions were complicated by ISH. In the evaluation period compared with the basal run-in, there was a statistically significant decrease of sessions with ISH in HF (9.8 to 8.0%, decrease of 18.4%; P = 0.011) and in HDF (10.6 to 5.2%, decrease of 50.9%; P < 0.001) compared with low-flux HD group (7.1 to 7.9%, increase of 9.9%).