End stage kidney disease (ESKD) patients on dialysis suffer from poor quality of life including sleep disorders, physical functioning, and depression. HDFIT a prospective, multi-center, unblinded, randomized control trial (RCT) is designed to investigate the impact of dialysis modality (HDF versus HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes (1). The primary results of the HDFIT trial were focused on the physical activity (PA). The data from 195 patients between August 2016 and October 2017 showed that majority of the sessions achieved high convective volume with HDF with better solute removal compared to patients on HD. However, the effect on PA 24 hour after dialysis was not statistically different compared to HD (Figure 1) (2).

 

Figure 1. Average absolute step counts per 24 h after the end of dialysis in HDF vs. HD (2) (p. 1063).

 

With regards to the sleep duration, the study concluded that the dialysis modality (HDF vs. HD) had no effect on self-reported sleep duration (Figure 2). In both groups, dialysis in the 1st shifts adversely affected self-reported sleep duration. At 6 months, HDF patients slept 532 ± 74 min/night, HD patients 519 ± 80 min/night. At baseline, 1st shift patients slept 406 ± 86 min the night before HD, 534 ± 64 min the night after HD, and 496 ± 99 min the night between 2 non-HD days. Compared to patients in the 2nd and 3rd shifts, patients dialyzed in the 1st shift slept less in the night before dialysis.

 

Figure 2. Influence of dialysis modality (HDF vs. HD) on sleep duration (1) (p. 173).

 

OL-HDF may be indicated for all patients receiving hemodialysis because there are no known contraindications. Karkar et al. (3), assessed patients satisfaction level using modified questionnaires of the validated Kidney Disease Quality of Life-Short Form (KDQOL-SF) version 1.3. Compared to high flux HD, patients treated with high-efficiency post dilution on-line HDF significantly improved patients’ satisfaction and quality of life, including social, physical, and professional activities.

Potential clinical benefits observed in small clinical studies such as control of hyperphosphatemia, malnutrition, inflammation, anemia, infectious complications, joint pain, amyloidosis associated with dialysis, insomnia, irritability, restless leg syndrome, polyneuropathy, and itching could also help to improve patients’ quality of life (4-9).

References:

1. Han M, Guedes M, Larkin J, et al. Effect of Hemodiafiltration on Self-Reported Sleep Duration: Results from a Randomized Controlled Trial. Blood Purif. 2020;49(1-2):168-177. Available from: https://pubmed.ncbi.nlm.nih.gov/31851982/.
2. Pecoits-Filho R, Larkin J, Poli-de-Figueiredo CE, et al. Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial. Nephrol Dial Transplant  Off Publ Eur  Dial Transpl Assoc – Eur Ren Assoc. Published online November 2020.
3. Karkar A, Abdelrahman M, Locatelli F. A Randomized Trial on Health-Related Patient Satisfaction Level with High-Efficiency Online Hemodiafiltration versus High-Flux Dialysis. Blood Purif. 2015;40(1):84-91.
4. Wolley M, Jardine M, Hutchison CA. Exploring the Clinical Relevance of Providing Increased Removal of Large Middle Molecules. Clin J Am Soc Nephrol. 2018;13(5):805-814. Available from: http://cjasn.asnjournals.org/lookup/doi/10.2215/CJN.10110917.
5. Tiranathanagul K, Praditpornsilpa K, Katavetin P, et al. On-line Hemodiafiltration in Southeast Asia: A Three-year Prospective Study of a Single Center. Ther Apher Dial. 2009;13(1):56-62. Available from: https://doi.org/10.1111/j.1744-9987.2009.00654.x.
6. Savica V, Ciolino F, Monardo P, et al. Nutritional Status in Hemodialysis Patients: Options for On-Line Convective Treatment. J Ren Nutr. 2006;16(3):237-240. Available from: https://www.sciencedirect.com/science/article/pii/S1051227606000926.
7. Cavallari C, Dellepiane S, Fonsato V, et al. Online Hemodiafiltration Inhibits Inflammation-Related Endothelial Dysfunction and Vascular Calcification of Uremic Patients Modulating miR-223 Expression in Plasma Extracellular Vesicles. J Immunol. 2019;202(8):2372-2383.
8. Pedrini LA, De Cristofaro V, Comelli M, et al. Long-term effects of high-efficiency on-line haemodiafiltration on uraemic toxicity. A multicentre prospective randomized study. Nephrol Dial Transplant  Off Publ Eur  Dial Transpl Assoc – Eur Ren Assoc. 2011;26(8):2617-2624.
9. Penne EL, van der Weerd NC, van den Dorpel MA, et al. Short-term effects of online hemodiafiltration on phosphate control: a result from the randomized controlled Convective Transport Study (CONTRAST). Am J Kidney Dis. 2010;55(1):77-87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19962805.

GMO-000122  Rev B  06/2024