Effects of high-volume online mixed-hemodiafiltration on anemia management in dialysis patients

PLoS One. 2019 Feb 22;14(2):e0212795. doi: 10.1371/journal.pone.0212795. eCollection 2019.

Abstract

Background: Anemia is a major comorbidity of patients with end-stage renal disease and poses an enormous economic burden to health-care systems. High dose erythropoiesis-stimulating agents (ESAs) have been associated with unfavorable clinical outcomes. We explored whether mixed-dilution hemodiafiltration (Mixed-HDF), based on its innovative substitution modality, may improve anemia outcomes compared to the traditional post-dilution hemodiafiltration (Post-HDF).

Methods: We included 174 adult prevalent dialysis patients (87 on Mixed-HDF, 87 on Post-HDF) treated in 24 NephroCare dialysis centers between January 2010 and August 2016 into this retrospective cohort study. All patients were dialyzed three times per week and had fistula/graft as vascular access. Patients were matched at baseline and followed over a one-year period. The courses of hemoglobin levels (Hb) and monthly ESA consumption were compared between the two groups with linear mixed models.

Results: Mean baseline Hb was 11.9±1.3 and 11.8±1.1g/dl in patients on Mixed- and Post-HDF, respectively. While Hb remained stable in patients on Mixed-HDF, it decreased slightly in patients on Post-HDF (at month 12: 11.8±1.2 vs 11.1±1.2g/dl). This tendency was confirmed by our linear mixed model (p = 0.0514 for treatment x time interaction). Baseline median ESA consumption was 6000 [Q1:0;Q3:16000] IU/4 weeks in both groups. Throughout the observation period ESA doses tended to be lower in the Mixed-HDF group (4000 [Q1:0;Q3:16000] vs 8000 [Q1:0;Q3:20000] IU/4 weeks at month 12; p = 0.0791 for treatment x time interaction). Sensitivity analyses, adjusting for differences not covered by matching at baseline, strengthened our results (Hb: p = 0.0124; ESA: p = 0.0687).

Conclusions: Results of our explorative study suggest that patients on Mixed-HDF may have clinical benefits in terms of anemia management. This may also have a beneficial economic impact. Future studies are needed to confirm our hypothesis-generating results and to provide additional evidence on the potential beneficial effects of Mixed-HDF.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Anemia* / blood
  • Anemia* / complications
  • Anemia* / therapy
  • Female
  • Follow-Up Studies
  • Hematinics / administration & dosage*
  • Hemodiafiltration*
  • Hemoglobins / metabolism
  • Humans
  • Kidney Failure, Chronic* / blood
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Male
  • Middle Aged
  • Models, Biological*
  • Retrospective Studies

Substances

  • Hematinics
  • Hemoglobins

Grants and funding

The authors received no specific funding for this work. As all authors are employees of Fresenius Medical Care or NephroCare, the salaries of all authors are paid by the two companies [Fresenius Medical Care: AMZ, ACW, JP, GK, MW, AsFe, CB, StSt, BC, AG; NephroCare: LAP, PR, AnFe]. The corporation did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript, whereas the specific roles of the individual authors are articulated in the ‘author contributions’ section.