Kidney Week

Abstract: PUB146

Post-dilution High-Volume Online-Hemodiafiltration Versus High-Flux Hemodialysis Mortality Outcome in Patients with End-Stage Kidney Disease

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Alkemary, Alkhateeb K., Diaverum Holding AB branch, Riyadh, Saudi Arabia

Alkhateeb K. Alkemary, MD, PhD

• Fadlallah, Ayman Seddik, Diaverum Holding AB branch, Riyadh, Saudi Arabia

Ayman Seddik Fadlallah, MD, FASN

• Helal, Imed, Diaverum Holding AB branch, Riyadh, Saudi Arabia

Imed Helal, MD

• Alhomrany, Mohammed A., Diaverum Holding AB branch, Riyadh, Saudi Arabia

Mohammed A. Alhomrany, MD

• Al-Ghamdi, Saeed, Diaverum Holding AB branch, Riyadh, Saudi Arabia

Saeed Al-Ghamdi, MD

• Mousa, Dujanah Hassan, Diaverum Holding AB branch, Riyadh, Saudi Arabia

Dujanah Hassan Mousa, MD

• Alharbi, Ali, Diaverum Holding AB branch, Riyadh, Saudi Arabia

Ali Alharbi

Background

Several studies showed improved survival with high volume online hemodiafiltration (OL-HDF) over high-flux hemodialysis (HF-HD), but still with some limitations.

Methods

A retrospective multicentre cohort study with the main predictor high-volume post-dilution OL-HDF with convective volume ≥ 22 Litres/ session versus HF-HD. The primary endpoint was all-cause mortality during the 48-month follow-up period. 8006 patients were screened; 480 (6%) were excluded due to a change of dialysis modality, 790 (9.8%) were excluded for not being capable of achieving convective volume ≥ 22 Litres/ session, 6736 patients were analysed; 2324 (34.5%) were on high-volume OL-HDF & 4412 (65.5%) were on HF-HD.

Results

Online HDF group included significantly younger patients than HF-HD group with the age (mean±SD) (57.7±16.9) & (51.9±15.1) years, respectively, (p-value <0.001). And a significantly lower proportion of diabetic patients in the OL-HDF group (41.3%) than in the HF-HD group (52.4%), (p-value <0.001), with a significantly lower proportion of patients with a high Charlson comorbidity index > 6, (29.5%) versus (47.1%). And a significantly higher proportion of patients with arteriovenous fistula (95.7%) versus (71.1%). Patients on OL-HDF showed significantly lower overall mortality in comparison to HF-HD n(%) 304(13%) & 842(19.1%) respectively, (p-value <0.001), with a lower cardiovascular and cerebrovascular mortality rate of 171 (7.4%) & 484(11%) (p-value <0.001), and lower infection-related mortality 92(4%) & 268(6.1%) (p-value <0.001). Multivariate Cox-regression analysis showed survival advantage of OL-HDF versus HF-HD (HR, 0.72: 95% CI [0.63-0.83]) (p-value <0.001).

Conclusion

Patients with kidney failure who received high-volume OL-HDF had a lower risk of all cause mortality, cardiovascular mortality, and infection-related mortality than those who received HF-HD.

Caplan-Meier Survival Curve