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International Urology and Nephrology

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01-10-2013 | Nephrology - Original Paper

Effects of high efficiency post-dilution on-line hemodiafiltration or conventional hemodialysis on residual renal function and left ventricular hypertrophy

Authors: Helmut Schiffl, Susanne M. Lang, Rainald Fischer

Published in: International Urology and Nephrology | Issue 5/2013

Abstract

Purpose

Residual renal function (RRF) contributes to dialysis adequacy, quality of life and survival of hemodialysis patients. There is an ongoing debate whether better preservation of residual renal function is the result of chronic fluid volume overload. Our prospective investigation analyzed the effects of different dialytic therapies on RRF and left ventricular hypertrophy, which may be considered—at least in part—a surrogate marker of chronic fluid overload.

Methods

Two cohorts of end-stage renal disease patients initiating renal replacement therapy (high efficiency post-dilution on-line hemodiafiltration (HDF) in 58 patients, conventional hemodialysis (HD) in 60 patients) were prospectively followed up. RRF was determined at baseline, 12 and 24 months, left ventricular mass index (LVMI) at baseline and after 24 months.

Results

Demographic and renal characteristics, medication or exposure to nephrotoxins were comparable among the two cohorts of patients. RRF declined in all patients throughout the 2-year study period. In HDF patients, the decline was less pronounced (28 %) than in conventional HD patients (68 %). More patients undergoing HD received cardio- and renoprotective antihypertensive drugs. CRP levels were significantly higher in conventional HD. Hypotensive episodes were fewer in HDF. LVMI decreased in 90 % of HDF compared to only 25 %of HD patients.

Conclusions

Our data clearly indicate that better preservation of RRF by high efficiency hemodiafiltration is not associated with left ventricular hypertrophy.

Brener ZZ, Thijssen S, Kotanko P, Kuhlmann MK, Bergman M, Winchester JF, Levin NW (2011) The impact of residual renal function on hospitalization and mortality in incident hemodialysis patients. Blood Purif 31:243–251PubMedCrossRef

Shafi T, Jaar BG, Plantinga LC, Fink NE, Sadler JH, Parekh RS, Powe NR, Coresh J (2010) Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the choices for healthy outcomes in caring for end-stage renal disease (CHOICE) study. Am J Kidney Dis 56:348–358PubMedCrossRef

Shemin D, Bostom AG, Laliberty P, Dworkin LD (2001) Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis 38:85–90PubMedCrossRef

Vilar E, Wellsted D, Chandna SM, Greenwood RN, Farrington K (2009) Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant 24:2502–2510PubMedCrossRef

National Kidney Foundation (2006) KDOQI Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 48:S2–S90CrossRef

Lysaght MJ, Vonesh EF, Gotch F, Ibels L, Keen M, Lindholm B, Nolph KD, Pollock CA, Prowant B, Farrell PC (1991) The influence of dialysis treatment modality on the decline of remaining renal function. ASAIO Trans 37:598–604PubMed

Horinek A, Misra M (2004) Does residual renal function decline more rapidly in hemodialysis than in peritoneal dialysis? How good is the evidence? Adv Perit Dial 20:137–140PubMed

Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT (2002) Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 62:1046–1053PubMedCrossRef

Schiffl H, Lang SM, Fischer R (2002) Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients. Nephrol Dial Transplant 17:1814–1818PubMedCrossRef

10.

Lang SM, Bergner A, Topfer M, Schiffl H (2001) Preservation of residual renal function in dialysis patients: effects of dialysis-technique-related factors. Perit Dial Int 21:52–57PubMed

11.

Hartmann J, Fricke H, Schiffl H (1997) Biocompatible membranes preserve residual renal function in patients undergoing regular hemodialysis. Am J Kidney Dis 30:366–373PubMedCrossRef

12.

McKane W, Chandna SM, Tattersall JE, Greenwood RN, Farrington K (2002) Identical decline of residual renal function in high-flux biocompatible hemodialysis and CAPD. Kidney Int 61:256–265PubMedCrossRef

13.

Hyodo T, Koutoku N (2011) Preservation of residual renal function with HDF. Contrib Nephrol 168:204–212PubMedCrossRef

14.

Covic A, Goldsmith DJ, Georgescu G, Venning MC, Ackrill P (1996) Echocardiographic findings in long-term, long-hour hemodialysis patients. Clin Nephrol 45:104–110PubMed

15.

Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE (2000) Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J Am Soc Nephrol 11:912–916PubMed

16.

Paoletti E, Specchia C, Di MG, Bellino D, Damasio B, Cassottana P, Cannella G (2004) The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey. Nephrol Dial Transplant 19:1829–1834PubMedCrossRef

17.

Haag-Weber M (2008) The impact of residual renal function on survival. Nephrol Dial Transplant 23:2123–2126PubMedCrossRef

18.

Canaud B (2008) Residual renal function: the delicate balance between benefits and risks. Nephrol Dial Transplant 23:1801–1805PubMedCrossRef

19.

Gunal AI, Kirciman E, Guler M, Yavuzkir M, Celiker H (2004) Should the preservation of residual renal function cost volume overload and its consequence left ventricular hypertrophy in new hemodialysis patients? Ren Fail 26:405–409PubMedCrossRef

20.

European Best Practice Guidelines on Haemodialysis.(Part 1) (2002) Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant 17(suppl 7):7–15

21.

Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083PubMedCrossRef

22.

Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458PubMedCrossRef

23.

Shin SK, Noh H, Kang SW, Seo BJ, Lee IH, Song HY, Choi KH, Ha SK, Lee HY, Han DS (1999) Risk factors influencing the decline of residual renal function in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 19:138–142PubMed

24.

Vaslaki LR, Berta K, Major L, Weber V, Weber C, Wojke R, Passlick-Deetjen J, Falkenhagen D (2005) On-line hemodiafiltration does not induce inflammatory response in end-stage renal disease patients: results from a multicenter cross-over study. Artif Organs 29:406–412PubMedCrossRef

25.

Glassock RJ, Pecoits-Filho R, Barberato SH (2009) Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol 4(Suppl 1):S79–S91PubMedCrossRef

26.

Ardeleanu S, Panaghiu L, Prisada O, Sascau R, Voroneanu L, Hogas S, Mardare N, Covic A (2011) Regression of left ventricular hypertrophy in hemodialyzed patients is possible: a follow-up study. Int Urol Nephrol 43:1161–1169PubMedCrossRef

27.

Kong CH, Farrington K (2003) Determinants of left ventricular hypertrophy and its progression in high-flux haemodialysis. Blood Purif 21:163–169PubMedCrossRef

28.

Palmieri V, Tracy RP, Roman MJ, Liu JE, Best LG, Bella JN, Robbins DC, Howard BV, Devereux RB (2003) Relation of left ventricular hypertrophy to inflammation and albuminuria in adults with type 2 diabetes: the strong heart study. Diabetes Care 26:2764–2769PubMedCrossRef

29.

Masiha S, Sundstrom J, Lind L (2012) Inflammatory markers are associated with left ventricular hypertrophy and diastolic dysfunction in a population-based sample of elderly men and women. J Hum Hypertens doi:10.1038/jhh.201.113

30.

Ohtake T, Oka M, Ishioka K, Honda K, Mochida Y, Maesato K, Moriya H, Hidaka S, Kobayashi S (2012) Cardiovascular protective effects of on-line hemodiafiltration: comparison with conventional hemodialysis. Ther Apher Dial 16:181–188PubMedCrossRef

31.

Alvestrand A, Ledebo I, Hagerman I, Wingren K, Mattsson E, Qureshi AR, Gutierrez A (2011) Left ventricular hypertrophy in incident dialysis patients randomized to treatment with hemofiltration or hemodialysis: results from the ProFil study. Blood Purif 32:21–29PubMedCrossRef

32.

Schmid H, Schiffl H (2012) Hemodiafiltration and survival of end-stage renal disease patients: the long journey goes on. Int Urol Nephrol 44:1435–1440PubMedCrossRef

Title: Effects of high efficiency post-dilution on-line hemodiafiltration or conventional hemodialysis on residual renal function and left ventricular hypertrophy
Authors: Helmut Schiffl
Susanne M. Lang
Rainald Fischer
Publication date: 01-10-2013
Publisher: Springer Netherlands
Published in: International Urology and Nephrology / Issue 5/2013
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-012-0336-4

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Abstract

Purpose

Methods

Results

Conclusions

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