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online HDF

Francesco Ramponi, Claudio Ronco, Giacomo Mason, Enrico Rettore, Daniele Marcelli, Francesca Martino, Mauro Neri, Alejandro Martin-Malo, Bernard Canaud, Francesco Locatelli
BACKGROUND: Clinical studies suggest that hemodiafiltration (HDF) may lead to better clinical outcomes than high-flux hemodialysis (HF-HD), but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD. METHODS: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1) estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2) simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3) application of state-specific health-related quality of life coefficients and differential costs derived from the literature...
2016: ClinicoEconomics and Outcomes Research: CEOR
Zuray Corredor, Lara Rodríguez-Ribera, Irene Silva, Juan Manuel Díaz, José Ballarín, Ricard Marcos, Elisabet Coll, Susana Pastor
Chronic kidney disease (CKD) patients exhibit high levels of genetic damage. Part of this genetic damage is supposed to be caused by the hemodialysis (HD) therapy. Different and more efficient HD procedures could reduce the genetic damage and improve health status of CKD patients. In the present study, we analyzed if changing to online hemodiafiltration (OL-HDF) has a beneficial effect on the levels of genetic damage. The levels of genetic damage (DNA breaks and oxidatively damaged DNA) were analyzed in peripheral blood lymphocytes by using the comet assay...
September 15, 2016: Mutation Research. Genetic Toxicology and Environmental Mutagenesis
Soraya Abad, Almudena Vega, Borja Quiroga, David Arroyo, Nayara Panizo, Javier Eduardo Reque, Juan Manuel López-Gómez
: Chronic kidney disease is associated with an increased risk of cardiovascular events. In recent years, protein-bound toxins have become more important due to their association with increased morbidity and mortality, characterised by inadequate clearance during dialysis. The purpose of this study is to assess the influence of high convective volumes on postdilution online haemodiafiltration (OL-HDF) on the removal of medium-sized molecules, small molecules and protein-bound molecules...
August 30, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Boaz Gedaliahu Samolsky Dekel, Gabriele Donati, Alessio Vasarri, Anna Laura Croci Chiocchini, Alberto Gori, Giuseppe Cavallari, Gianfranco Di Nino, Laura Mercolini, Michele Protti, Roberto Mandrioli, Rita Maria Melotti, Gaetano La Manna
OBJECTIVES: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. METHODS: We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone...
September 2, 2016: Pain Practice: the Official Journal of World Institute of Pain
Carlo Basile, Andrew Davenport, Peter J Blankestijn
The mortality rate of patients on maintenance dialysis remains alarmingly high, at approximately 15-20 % per year. Increasing dialyzer urea clearance has not been shown to improve survival and hence interest has shifted towards convective therapies, such as hemodiafiltration (HDF) which can remove middle molecular weight uremic toxins, which have been suggested to increase mortality in patients with end-stage kidney disease. During the last few years, four large prospective randomized controlled trials (RCTs) have been conducted in different European countries to compare survival outcomes in prevalent patients receiving conventional hemodialysis with online post-dilution HDF (OL HDF)...
September 1, 2016: Journal of Nephrology
M Almada, C Amaral, M Diniz-da-Costa, G Correia-da-Silva, N A Teixeira, B M Fonseca
Endocannabinoids (eCBs) are endogenous mediators that along with the cannabinoid receptors (CB1 and CB2), a membrane transporter and metabolic enzymes form the endocannabinoid system (ECS). Several eCBs have been discovered with emphasis on anandamide (AEA). They are involved in several biological processes such as energy balance, immune response and reproduction. Decidualization occurs during the secretory phase of human menstrual cycle, which involves proliferation and differentiation of endometrial stromal cells into decidual cells and is crucial for the establishment and progression of pregnancy...
October 2016: Reproduction: the Official Journal of the Society for the Study of Fertility
Francisco Maduell, Raquel Ojeda, Marta Arias-Guillen, Florencia Rossi, Néstor Fontseré, Manel Vera, Nayra Rico, Leonardo Nicolás Gonzalez, Gastón Piñeiro, Mario Jiménez-Hernández, Lida Rodas, José Luis Bedini
BACKGROUND: New haemodialysis therapeutic regimens are required to improve patient survival. Longer and more frequent dialysis sessions have produced excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. METHODS: In this single-centre observational study, 57 patients on 4-5-hour thrice-weekly OL-HDF were switched to nocturnal every-other-day OL-HDF. Inclusion criteria consisted of stable patients with good prospects for improved occupational, psychological and social rehabilitation...
2016: Nephron
Andrew Davenport
Recent reports suggest a survival advantage for dialysis patients treated by postdilutional online hemodiafiltration (OL-HDF) who achieve higher volume convective exchanges. As such, the factors associated with achieving higher convective volume exchange were determined. The convective exchange volumes during the midweek OL-HDF session in a cohort of 653 patients with corresponding bio-impedance measurements of volume status and sessional electronic records were audited. Mean patient age was 64.9 ± 14...
May 26, 2016: Artificial Organs
Ping Jia, Wei Jin, Jie Teng, Hao Zhang, Jianzhou Zou, Zhonghua Liu, Bo Shen, Xuesen Cao, Xiaoqiang Ding
Endothelial dysfunction and chronic inflammatory process are prevalent in patients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD). The aim of this study was to evaluate the acute and short-term effects of online hemodiafiltration (OL-HDF) versus conventional HD on endothelial function and inflammation. A prospective, randomized, crossover trial. Twenty stable ESRD patients undergoing chronic HD treatments were randomly assigned with a 1:1 ratio to conventional HD and to OL-HDF both for 2 weeks (either HD followed by OL-HDF or OL-HDF followed by HD)...
April 2016: Medicine (Baltimore)
Ikuto Masakane, Shigeru Nakai, Satoshi Ogata, Naoki Kimata, Norio Hanafusa, Takayuki Hamano, Kenji Wakai, Atsushi Wada, Kosaku Nitta
A nationwide survey of 4325 dialysis facilities was conducted at the end of 2013, among which 4268 (98.7%) responded. The number of new dialysis patients was 38,095 in 2013. Since 2008, the number of new dialysis patients has remained almost the same without any marked increase or decrease. The number of dialysis patients who died in 2013 was 30,751. The dialysis patient population has been growing every year in Japan; it was 314,438 at the end of 2013. The number of dialysis patients per million at the end of 2013 was 2470...
December 2015: Therapeutic Apheresis and Dialysis
Leonilde Amado, Nuno Ferreira, Vasco Miranda, Patricia Meireles, Verónica Povera, Ricardo Ferreira, João Fazendeiro-Matos, Laetitia Teixeira, Constança Paúl, Alice Santos-Silva, Elísio Costa
INTRODUCTION: Non-adherence to therapeutic regimens is a recognised problem in the dialysis population that compromises the opportunity to achieve maximum treatment effect and, therefore, might lead to increased morbidity and mortality. In this study, we aimed to evaluate the prevalence of self-reported medication non-adherence in patients with end-stage kidney disease (ESKD) undergoing online-haemodiafiltration (OL-HDF), as well as to evaluate the factors that could affect medication adherence...
December 2015: Journal of Renal Care
Francisco Maduell, Francesc Moreso, Josep Mora-Macià, Mercedes Pons, Rosa Ramos, Jordi Carreras, Jordi Soler, Ferrán Torres
BACKGROUND: The ESHOL study showed that post-dilution online haemodiafiltration (OL-HDF) reduces all-cause mortality versus haemodialysis. However, during the observation period, 355 patients prematurely completed the study and, according to the study design, these patients were censored at the time of premature termination. METHODS: The aim of this study was to investigate the outcome of patients who discontinued the study. RESULTS: During follow-up, 207 patients died while under treatment and 47 patients died after discontinuation of the study...
2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Marta Albalate Ramón, Patricia de Sequera Ortiz, Rafael Pérez-García, Elena Corchete Prats, Roberto Alcázar Arroyo, Mayra Ortega Díaz, Marta Puerta Carretero
INTRODUCTION: In post-dilution online hemodiafiltration (OL-HDF), the only recommendation concerning the dialysate, or dialysis fluid, refers to its purity. No study has yet determined whether using a high dialysate flow (Qd) is useful for increasing Kt or ultrafiltration-infusion volume. OBJECTIVE: Study the influence of Qd on Kt and on infusion volume in OL-HDF. MATERIAL AND METHODS: This was a prospective crossover study. There were 37 patients to whom 6 sessions of OL-HDF were administered at 3 different Qds: 500, 600 and 700ml/min...
November 2015: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Sanne A E Peters, Michiel L Bots, Bernard Canaud, Andrew Davenport, Muriel P C Grooteman, Fatih Kircelli, Francesco Locatelli, Francisco Maduell, Marion Morena, Menso J Nubé, Ercan Ok, Ferran Torres, Mark Woodward, Peter J Blankestijn
BACKGROUND: Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials (RCTs) comparing HDF with conventional HD on all-cause and cause-specific mortality in end-stage kidney disease (ESKD) patients reported inconsistent results and were at high risk of bias. We conducted a pooled individual participant data analysis of RCTs to provide the most reliable evidence to date on the effects of HDF on mortality outcomes in ESKD patients...
June 2016: Nephrology, Dialysis, Transplantation
Andrew Davenport, Sanne A E Peters, Michiel L Bots, Bernard Canaud, Muriel P C Grooteman, Gulay Asci, Francesco Locatelli, Francisco Maduell, Marion Morena, Menso J Nubé, Ercan Ok, Ferran Torres, Mark Woodward, Peter J Blankestijn
Mortality remains high for hemodialysis patients. Online hemodiafiltration (OL-HDF) removes more middle-sized uremic toxins but outcomes of individual trials comparing OL-HDF with hemodialysis have been discrepant. Secondary analyses reported higher convective volumes, easier to achieve in larger patients, and improved survival. Here we tested different methods to standardize OL-HDF convection volume on all-cause and cardiovascular mortality compared with hemodialysis. Pooled individual patient analysis of four prospective trials compared thirds of delivered convection volume with hemodialysis...
January 2016: Kidney International
Francesco Locatelli, Leano Violo, Selena Longhi, Lucia Del Vecchio
BACKGROUND: Standard low-flux haemodialysis (HD) is not very efficacious, and patient morbidity and mortality rates are still very high. According to the initial study design, the MPO study reported that high-flux HD (hf-HD) showed a significant 37% relative risk reduction of mortality in patients with serum albumin ≤4 g/dl; online haemodiafiltration (HDF) is considered the most efficient technique of using high-flux membranes, as clearances of small solutes, like urea, are higher than in haemofiltration and clearances of middle solutes, like β2-microglobulin, are higher than in hf-HD...
2015: Blood Purification
Francisco Maduell
BACKGROUND: Retrospective randomized clinical studies have shown that online hemodiafiltration (OL-HDF) is associated with a lower risk reduction of mortality than standard hemodialysis. SUMMARY: In all of these large randomized studies, the convective volume seemed to be an important issue, but the optimal OL-HDF dose has not yet been defined. This article, to make a EUDIAL working group position, reviews the association between survival and convective volume, the minimum recommended replacement volume, the importance of the infusion flow rate, and the main limiting factors in achieving a high convective volume...
2015: Blood Purification
Tadao Akizawa, Fumihiko Koiwa
Many pieces of evidence of online hemodiafiltration (HDF) have been reported, and the clinical advantage of postdilution online HDF with sufficient substitution is now established. After the approval of online HDF in 2012, the number of online HDF patients has been dramatically increasing in Japan and reached 10% of the total dialysis population at the end of 2013. One of the marked characteristics of Japanese online HDF is a widespread use of predilution treatment and, in 2013, 90.8% of online HDFs were carried out with the predilution mode...
2015: Blood Purification
Francisco Maduell, Raquel Ojeda, Marta Arias-Guillén, Giannina Bazan, Manel Vera, Néstor Fontseré, Elisabeth Massó, Miquel Gómez, Lida Rodas, Mario Jiménez-Hernández, Gastón Piñeiro, Nayra Rico
INTRODUCTION: Online hemodiafiltration (OL-HDF) is currently the most effective technique. Several randomized studies and meta-analyses have observed a reduction in mortality as well as a direct association with convective volume. Currently, it has not been well established whether a larger dialyzer surface area could provide better results in terms of convective and depurative effectiveness. The aim of this study was to assess the effect of larger dialyzer surface areas on convective volume and filtration capacity...
2015: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Claire H den Hoedt, Muriel P C Grooteman, Michiel L Bots, Peter J Blankestijn, Ingeborg van der Tweel, Neelke C van der Weerd, E Lars Penne, Albert H A Mazairac, Renée Levesque, Piet M ter Wee, Menso J Nubé, Marinus A van den Dorpel
BACKGROUND: Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections. PATIENTS AND METHODS: We used data of the 714 HD patients (age 64 ±14, 62% men, 25% Diabetes Mellitus, 7% catheters) participating in the CONvective TRAnsport STudy (CONTRAST), a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD...
2015: PloS One
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