Monday, January 21, 2013

eJournal Club - Hemodiafiltration

A few years ago, a unit that I worked at started using hemodiafiltration (HDF) routinely for the first time. Prior to starting our patients, we visited another unit where they had been using HDF for a few years and interviewed some patients who had undergone both methods. The patients uniformly said that they felt better on HDF than they had before on regular HD. Of course, part of this may have been psychological - the fact that they knew that they were getting a new, "special" treatment.

HDF works by combining diffusion with convection and is known to clear middle molecules better than HD alone. Unfortunately however, some of the proposed benefits of HDF have not played out as expected. HDF has been shown to have no mortality or CVD benefit over HD. Still, there were hints from various studies that there may be a benefit in terms of health-related quality of life (HRQOL) for patients on HDF. For patients on dialysis, this would be a big deal. This month's article highlighted in eJournal club attempted to answer this question.

This was a randomized trial using data from the CONTRAST study comparing HD with HDF. HRQOL was a prespecified secondary outcome. Over an average of two years follow-up all domains of HRQOL declined except for overall health which improved in the HDF patients although there was no significant difference from the HD patients. These results were disappointing.

Head over the eJournal Club to continue the discussion.


T-diddy said...

In fact at the 2013 RRI meeting we looked at all of the published trials comparing HDF to HD. This includes CONTRAST, Italian C/D, Turkish HDF trial. Still waiting for data from ESCHOL results -- coming in 2013.

Lots of secondary and post-hoc analyses to favor HDF. Not good enough for some to change their practice.

Blog from RRI meeting here:

Gearoid McMahon said...

Thanks, I look forward to seeing the results.