Hemodiafiltration reduces risk of dying over the course of a 3-year study

A technique that removes additional toxins during dialysis may prolong kidney failure patients' lives, according to a clinical trial appearing in an upcoming issue of the Journal of the American Society Nephrology. In light of these results, the technique may become standard for dialysis patients.

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.

The findings indicate that OL-HDF may indeed prolong kidney failure patients' lives compared with conventional hemodialysis. "Mortality remains very high in dialysis patients, ranging from 15% to 25% annually. Any reduction of this mortality would be an important achievement," said Dr. Maduell. "In view of this study's results, OL-HDF may become the first-line option in hemodialysis patients," he added.