At the Foot of the Hemodialysis Room: Online Hemodiafiltration and High-Flux Hemodialysis, a Multicenter Study

Abstract

Background: Several studies highlight the relevance of convective transport versus diffusive transport in the elimination of substances of higher molecular weight with great advantages in the prevention of chronic complications. Convective techniques improve them substantially. Among them, on-line hemodiafiltration (HDF-OL) is the one that eliminates more medium and high molecular weight toxins, although high-flux hemodialysis with high permeability dialyzers comes close to the advantages offered by HDF-OL. The aim of the present study is to estimate whether there are differences in the different parameters between high-flux hemodialysis (HD-FH) and OL-HDF. Methods: Multicenter, retrospective, descriptive study, analyzing the evolution in one year in both techniques. Variables of interest: demographics, Charlson comorbidity index, Karnofsky index, analytical parameters (urea kinetics, nutrition, inflammation, bone-mineral metabolism, anemia, dyslipidemia), interdialysis weight gain, diabetes, arterial hypertension and hospitalization among others. Results: A total of 1674 in OL-HDF and 889 in HD-HF. No differences in: sex, diabetes, etiology of nephropathy, physical activity, smoking, months on dialysis, dry weight, interdialysis gain. There were statistically significant differences in favor of OL-HDF in: KtV, ß2-microglobulin, hemoglobin levels and PTH. In favor of HDF-HF-HDF: albumin and aluminum. The proportion of hospitalized patients was higher in the OL-HDF group (41%) compared to the high-flow HD group (37%) (p 0.044). Conclusion: These results highlight the complexity of choosing the optimal dialysis technique, which must be customized according to the patient's specific needs and clinical situation. Although OL-HDF offers advantages in the removal of larger toxins, which is crucial to prevent chronic complications, the observed hospitalization rate suggests the need for vigilance. Funding: Other NIH Support - Diaverum Renal Services, SL, Other U.S. Government Support