Comparison of intradialytic plasma volume change between online hemodiafiltration and standard hemodialysis

BackgroundIntradialytic plasma volume change (IPVC) owing to ultrafiltration is a dominant cause of intradialytic hypotension (IDH). Lower occurrence of IDH in hemodiafiltration (HDF) than in standard hemodialysis (std-HD) indicates that HDF has preventive effect on IPVC. This study examined whether online HDF (ol-HDF) prevented IPVC compared with std-HD.MethodsIn 115 std-HD, 59 push-pull ol-HDF (pp-ol-HDF), 39 pre-dilution ol-HDF (pre-ol-HDF), and 33 post-dilution ol-HDF (post-ol-HDF) sessions, we calculated IPVC using intradialytic change of hemoglobin (IPVC.sub.Hb) and also using the change of hematocrit (IPVC.sub.Ht), and compared them in association with intradialytic body weight loss (IBWL) between the dialysis modes.ResultsBoth IPVC.sub.Hb and IPVC.sub.Ht were not different between the modes; in std-HD, pp-ol-HDF, pre-ol-HDF, and post-ol-HDF, IPVC.sub.Hb were 0.10 [+ or -] 0.06, 0.11 [+ or -] 0.07, 0.10 [+ or -] 0.05, and 0.10 [+ or -] 0.06, respectively, and IPVC.sub.Ht were 0.10 [+ or -] 0.07, 0.11 [+ or -] 0.07, 0.10 [+ or -] 0.06, and 0.10 [+ or -] 0.06, respectively. IPVCs divided by relative IBWL to DW (IBWL/DW) were also not different between the modes; in std-HD, pp-ol-HDF, pre-ol-HDF, and post-ol-HDF, IPVC.sub.Hb/IBWL/DW were 1.9 [+ or -] 2.0, 1.7 [+ or -] 4.6, 2.1 [+ or -] 0.9, and 2.1 [+ or -] 1.8, respectively, and IPVC.sub.Ht/IBWL/DW were 1.9 [+ or -] 2.2, 1.9 [+ or -] 3.7, 2.1 [+ or -] 1.1, and 2.1 [+ or -] 2.0, respectively.ConclusionIrrespective of the modes, ol-HDF has the same level of IPVC as std-HD.Keywords: Hemodiafiltration, Hemodialysis, Hypotension, Plasma volume, Ultrafiltration