Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD

Francesco Locatelli, Paolo Altieri, Simeone Andrulli, Piergiorgio Bolasco, Giovanna Sau, Luciano A. Pedrini, Carlo Basile, Salvatore David, Mariano Feriani, Giovanni Montagna, Biagio Raffaele Di Iorio, Bruno Memoli, Raffaella Cravero, Giovanni Battaglia, Carmine Zoccali

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Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. In this multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n = 70), online predilution hemofiltration (HF; n = 36), or online predilution hemodiafiltration (HDF; n = 40). The primary end point was the frequency of intradialytic symptomatic hypotension (ISH). Compared with the run-in period, the frequency of sessions with ISH during the evaluation period increased for HD (7.1 to 7.9%) and decreased for both HF (9.8 to 8.0%) and HDF (10.6 to 5.2%) (P <0.001). Mean predialysis systolic BP increased by 4.2 mmHg among those who were assigned to HDF compared with decreases of 0.6 and 1.8 mmHg among those who were assigned to HD and HF, respectively (P = 0.038). Multivariate logistic regression demonstrated significant risk reductions in ISH for both HF (odds ratio 0.69; 95% confidence interval 0.51 to 0.92) and HDF (odds ratio 0.46, 95% confidence interval 0.33 to 0.63). There was a trend toward higher dropout for those who were assigned to HF (P = 0.107). In conclusion, compared with conventional HD, convective therapies (HDF and HF) reduce ISH in long-term dialysis patients.

Original languageEnglish
Pages (from-to)1798-1807
Number of pages10
JournalJournal of the American Society of Nephrology
Issue number10
Publication statusPublished - 2010

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)


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