High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

TLDR

Retrospective studies suggest that online hemodiafiltration (OL‑HDF) may reduce mortality risk compared with standard hemodialysis in ESRD patients. We conducted a multicenter, open‑label randomized controlled trial of 906 chronic hemodialysis patients, randomizing them to standard HD (n = 450) or high‑efficiency postdilution OL‑HDF (n = 456), with all‑cause mortality as the primary outcome and cardiovascular mortality, hospitalization, tolerability, and laboratory data as secondary outcomes. OL‑HDF lowered all‑cause mortality by 30 % (HR 0.70), reduced cardiovascular mortality by 33 % and infection‑related mortality by 55 %, with a number needed to treat of eight to prevent one death, and also decreased hypotension‑complicated dialysis sessions and hospitalizations, confirming that high‑efficiency postdilution OL‑HDF reduces mortality versus conventional hemodialysis.

Abstract

Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.