Comparison of clinical outcomes of conventional hemodialysis and online hemodiafiltration

Background: Several studies have suggested that online hemodiafiltration (OL-HDF) may reduce the risk of mortality and improve quality of life of these patients compared with standard hemodialysis. Methods: Forty stable out patients on dialysis (20 patients on hemodialysis and 20 patients on online hemodiafiltration) above age of 18 years and dialysis vintage of more than 3 months were followed up for 18 months. Clinical, biochemical parameters of these patients along with the SF-36 score at baseline and after 18 months of follow up were assessed. Results: At 18 months, statistically significant difference was found between hemodialysis (HD) and OL- HDF groups in erythropoietin dose (p=0.047), urea reduction ratio (p=0.016), Kt/V (p=0.005), hemoglobin (p=0.043), serum albumin (p=0.002), phosphorus (p=0.024), parathyroid hormone (p=0.007), potassium (p=0.007), ?2 microglobulin (p=0.002), high sensitive c-reactive protein (p=0.037), and serum bicarbonate levels (p=0.022). We found statistically significant difference in intradialytic complications namely intradialytic hypotension, muscle cramps, simultaneous hypotension and muscle cramps and stoppage of dialysis. In terms of mortality, the difference was not statistically significant (p=0.052). Conclusions: Patients on OL- HDF were having better quality of life than patients on HD. Better solute clearance, anemia control, improved nutritional and Mineral bone disorder parameters were seen in OL-HDF. Less complications during dialysis were seen with OL-HDF. The difference in mortality rate between the HD group and OL- HDF group was not statistically significant.