Retrospective studies suggest that on-line hemodiafiltration (OL-HDF)—which is different from standard dialysis in that it uses so-called high convective transport to remove additional substances over a wide range of sizes—may reduce kidney failure patients' risk of dying prematurely compared with standard hemodialysis . However, results from prospective studies have contradicted this finding.
To investigate the issue further, Francisco Maduell, MD, PhD (Hospital Clinic, in Barcelona, Spain) and his colleagues conducted a multicenter, open-label, randomized controlled trial in which they assigned 906 dialysis patients either to continue hemodialysis or to switch to OL-HDF, with higher convective volume than in previous prospective trials. Patients were followed for three years.
Among the major findings over the course of the three-year study:
Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of dying from any cause, a 33% lower risk of dying from cardiovascular-related causes, and a 55% lower risk of dying from an infection. The study's findings suggest that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. Hospitalizations and dialysis sessions complicated by low blood pressure were lower in patients assigned to OL-HDF.