Clinical Benefits of On-Line Hemodiafiltration in ESRD Patients / 대한신장학회잡지

ABSTRACT

BACKGROUND: On-line hemodiafiltration (HDF) is a novel extracorporeal renal replacement therapy to increase the removal of middle molecules by convection and diffusion. This study was aimed to investigate the clinical benefit of on-line HDF. METHODS: Fifteen stable chronic renal failure patients who were maintaining on low-flux hemodialysis (HD) were switched to on-line HDF for 4 months. Blood pressure, solute clearance rate, anemia, nutrition, cardiac function, inflammatory markers, brain natriuretic peptide and subjective symptoms were compared. RESULTS: In the patients treated with HDF swiching from HD, the episode of intradialytic symptomatic hypotension was significantly decreased. In addition, KT/Vurea and urea reduction ratio as well as beta2-microglobulin clearance rate and reduction ratio were significantly increased, HDF treatment also decreased the pre-dialysis phosphorus levels and daily requirement of calcium carbonate. Furthermore, HDF treatment contributed to the reduction of erythropoietin dose to maintain similar hematocrit levels. Patients' dry weight was increased during HDF treatment without any change of serum albumin and nPCR levels. HDF treatment increased brain natriuretic peptide reduction ratio and improved subjective symptoms such as itching, headache, cramp and insomnia. Inflammatory markers such as hsCRP, IL-1beta, IL-6 and TNF-alpha were not changed by HDF treatment. CONCLUSION: Compared to conventional HD, on-line HDF may offer additional benefits with improved cardiovascular stability, enhanced middle molecule clearance, improvement of anemia and good control of subjective symptoms.