Death Risk Lower with Online Hemodiafiltration than Conventional HD
Online hemodiafiltration is associated with a decreased mortality risk compared with conventional hemodialysis (HD), data suggest.
Spanish researchers randomly assigned 906 patients on chronic HD to continue on conventional high-flux HD (450 patients) or switch to high-efficiency post-dilution online hemodiafiltration (456 patients). Compared with the HD group, the hemodiafiltration group had a significant 30% decreased risk of all-cause mortality, a 55% decreased risk of infection-related mortality, and a 61% decreased risk of stroke, according to findings published in the Journal of the American Society of Nephrology (2013;24:487-497). The study also showed that the hemodiafiltration group had a 33% lower risk of cardiovascular mortality, but this decrease was not significant.
The investigators, led by Francisco Maduell, MD, of Hospital Clinic, University of Barcelona, reported that the estimated number needed to treat showed that to prevent one death annually, eight patients would need to be switched from HD to online hemodiafiltration. To their knowledge, their study is the first prospective, randomized clinical trial to show that high-efficiency post-dilution online hemodiafiltration decreases all-cause mortality compared with conventional HD in the chronic prevalent population.