Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly
2017
Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the
riskof
mortality/morbidity compared to optimal high-flux
hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus
Hemodialysisin Elderly) study was to compare high-flux
hemodialysisand online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic
hemodialysispatients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux
hemodialysisor online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30–day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux
hemodialysisand online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a
statistical unitaccording to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and
muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of
metabolic bone diseasebiomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux
hemodialysisin the elderly.
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