Effects of online hemodiafiltration on anemia and nutritional status in chronic hemodialysis patients

Abstract

Background: Online hemodiafiltration (OL-HDF) offers considerable advantages in clearance of molecules of various sizes. However, evidence of clinical effects of OL-HDF is scarce in Korea. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF. Methods: Adult patients with end-stage renal disease undergoing hemodialysis (HD) were prospectively enrolled in a K-cohort (CRIS no. KCT0003281) from 6 tertiary hospitals in South Korea. We recruited 435 patients, 339 of whom were on HD at enrollment. One hundred eighty-two patients were followed for more than 24 months. Among them, 44 were switched to OL-HDF for more than 12 months without conversion to HD. We used a paired t test to compare baseline and 24-month follow-up results. Results: The mean age of the subjects was 61.2 +/- 12.2 years, and 62.6% were male. The baseline hemoglobin level was not significantly different between HD and OL-HDF group (10.61 +/- 1.15 vs. 10.46 +/- 1.03 g/dL, P = 0.437). However, the baseline serum protein and albumin levels were significantly lower in the OL-HDF group (6.82 +/- 0.49 vs. 6.59 +/- 0.48 g/dL, P= 0.006; 3.93 +/- 0.28 vs. 3.73 +/- 0.29 g/dL, P< 0.001). In patients switched to OL-HDF, levels of hemoglobin and serum albumin significantly increased (10.46 +/- 1.03 vs. 11.08 +/- 0.82 g/dL, P= 0.001; 3.73 +/- 0.29 vs. 3.87 +/- 0.30 g/dL, P = 0.001). The normalized protein catabolic rate decreased after 24 months, but the change was not significant (1.07 +/- 0.25 vs. 1.03 +/- 0.21 g/kg/day, P = 0.433). Although the dose of erythropoiesis-stimulating agent was lower in patients who converted to HDF, it was not significantly different (-115.7 +/- 189.7 vs. -170.5 +/- 257.1 P = 0.206). Conclusion: OL-HDF treatment over more than 12 months was associated with no harmful effects on anemia and nutritional status.