Neurocognitive Function with Conventional Hemodialysis Versus Post-Dilution Hemofiltration as Initial Treatment in ESKD patients. A randomized controlled trial. The DA-VINCI Study.

INTRODUCTION: The ideal modality choice and dialysis prescription during the first renal replacement therapy (RRT) session remains unclear. We conducted a pilot study to determine the safety risk for hemodialysis (HD) versus hemofiltration (HF) and its relationship with neurocognitive assessment on incident RRT patients.

METHODS: Twenty-four incident RRT patients were included. Patients were randomized to the conventional HD group or post-dilution HF group. Minimental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) tests were applied in all patients before and after session and brain MRI was performed in 7 patients from the conventional HD group and 8 patients from the post-dilution HF group before and after the intervention.

RESULTS: Baseline characteristics were similar between groups. Compared to conventional HD, post-dilution HF had longer treatment time. There were no significant changes in blood pressure after RRT in both groups. The MMSE test showed no significant differences between groups or within groups. The MOCA test showed an increase in the total score for the post dilution HF group with no significant changes between groups. The magnetic resonance image (MRI) evaluation showed no differences between or within groups.

CONCLUSION: Post-dilution hemofiltration is a safe alternative for the first hemodialysis session in incident RRT, it allows longer treatment time if ultrafiltration is required and has a similar neurological risk than conventional HD. This is a pilot study and that larger studies are needed to confirm the findings.