Abstract
BackgroundHemodiafiltration (HDF), as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH) as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions.MethodsSubjects were stratified into equal groups of percentiles of convective volume prescription: Group 1 of 0 to 7.53 liters, group 2 of 7.54 to 14.8 liters, group 3 of 14.9 to 16.96 liters, group 4 of 16.97 to 18.9 liters, group 5 of 21 to 19.9 liters and group 6 of 21.1 to 30 liters. Logistic Regression with and without adjustment for confounding factors was used to evaluate factors associated with the occurrence of IDH.Results2276 treatments of 154 patients were analyzed. IDH occurred during 239 HDF treatments (10.5% of all treatments). Group 1 showed 31 treatments (8.2%) with IDH whereas group 6 showed IDH in only 15 sessions (4% of all treatments). Odds Ratio of IDH for Group 6 was 0.47 (95% CI 0.25 to 0.88) as compared to Group 1 after adjustment.ConclusionsIn summary the data of this retrospective cohort study shows an inverse correlation between the occurrence of IDH and convective volume prescription. Further research in prospective settings is needed to confirm these findings.
Highlights
Hemodiafiltration (HDF), as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH) as compared to diffusive techniques
Patients were categorized in six equal groups according to percentiles of convective volume prescription data: Group 1: 0 to 7.53 liters, Group 2: 7.54 to 14.8 liters; Group 3: 14.9 to16.96 liters; Group 4: 116.97 to 18.9 liters; Group 5: 19.1 to 21 liters, and Group 6: 21.1 to 30 liters
Small significant differences between the groups were found for processed blood volume, total spent dialysate, blood and dialysate flow (Table 3)
Summary
Hemodiafiltration (HDF), as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH) as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions. Regular use of high-efficiency on line HDF is associated with reduced morbidity (better blood pressure control, improved lipid profile, improved anemia correction and phosphate control, improved removal of beta2-microglobulin, reduction of amyloidosis and hospitalization) [9,10,11]. It has been suggested that convective methods of blood purification may improve patient outcomes, which may include a reduction of intradialytic hypotensive episodes [14,15,16,17]
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