Abstract
BackgroundAll-cause mortality can be reduced in patients receiving European-style high-volume post-dilution online hemodiafiltration (post-OHDF) compared with hemodialysis (HD). Japanese-style high-volume pre-dilution online hemodiafiltration (pre-OHDF) can also decrease all-cause mortality. No studies have investigated survival in patients receiving Japanese-style post-OHDF, and directly compared survival between pre-OHDF and post-OHDF. This study sought to clarify these issues.MethodsWe conducted this retrospective observational study at multiple facilities of our medical corporation, which have similar quality of healthcare management, from July 1, 2017 to July 1, 2020. Japanese-style OHDF included pre-OHDF and post-OHDF. Pre-OHDF and post-OHDF were each divided into high-volume and low-volume subgroups. We compared 3-year all-cause mortality and cardiovascular events between OHDF and high-flux HD using propensity score matching. In addition, we examined the effects of different modalities through comparisons between high-volume and low-volume pre-OHDF and between pre-OHDF and post-OHDF.ResultsPost-OHDF was associated with significantly lower all-cause mortality (P = 0.004, log-rank test; hazard ratio [HR] 0.257, 95% confidence interval [CI] 0.094–0.701) and cardiovascular events during all 3 years (P < 0.05) compared with HD. High-volume post-OHDF was associated with lower all-cause mortality compared with hemodialysis (log-rank test P = 0.022) but low-volume post-OHDF was not. Pre-OHDF was also associated with lower all-cause mortality (P < 0.001, log-rank test; HR 0.316; 95% CI 0.212–0.472) compared with HD but was not associated with cardiovascular events. All-cause mortality did not significantly differ between post-OHDF and pre-OHDF.ConclusionsThese findings suggest that Japanese-style post-OHDF may improve all-cause mortality to a level similar to that of pre-OHDF and that post-OHDF, particularly high-volume post-OHDF may reduce cardiovascular events.
Highlights
All-cause mortality can be reduced in patients receiving European-style high-volume post-dilution online hemodiafiltration compared with hemodialysis (HD)
Some facilities increase the total Dialysate flow rate (QD) (QD including substitution volume) from 500 to 600–700 mL/min to compensate for the decrease in QD or keep the total QD constant at 500 mL/min to stabilize the environment in the hemodiafilter as in hemodialysis (HD), depending on the facility policy
Comparison of patient survival in the Online hemodiafiltration (OHDF), pre‐OHDF, and post‐OHDF groups versus the HD group Three-year all-cause mortality was significantly lower in the OHDF group than in the HD group (P < 0.001, log-rank test; hazard ratio [Hazard ratio (HR)] 0.276; 95% confidence interval [Confidence interval (CI)] 0.189–0.404; Additional file 11: Figure S1)
Summary
All-cause mortality can be reduced in patients receiving European-style high-volume post-dilution online hemodiafiltration (post-OHDF) compared with hemodialysis (HD). Japanese-style high-volume pre-dilution online hemodiafiltration (pre-OHDF) can decrease all-cause mortality. Online hemodiafiltration (OHDF) has two different modes, pre-dilution OHDF (pre-OHDF) and postdilution OHDF (post-OHDF), depending on where the substitution fluid is administered in the extracorporeal circuit. In post-OHDF in Europe, the CV is approximately 16–26 L (66.7–108.3 mL/ min) with low-permeability hemodiafilters, and substitution volumes greater than 20 L require increasing the blood flow rate (QB) to greater than 380 mL/ min in order to control the transmembrane pressure and filtration fraction [1]. In Japanese-style preOHDF and post-OHDF, the substitution volumes are approximately 24–84 L (100–350 mL/min) and 6–16 L (25.0–66.7 mL/min), respectively, with moderate- to high- permeability of the hemodiafilter. The difference in substitution volume in post-OHDF between Japan and Europe is mainly due to the permeability of the hemodiafilter
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
