Kidney Research and Clinical Practice 2020 Mar; 39(1): 103-111  https://doi.org/10.23876/j.krcp.19.082
Effects of online hemodiafiltration on anemia and nutritional status in chronic hemodialysis patients
Yu Ho Lee1,* , Yoon Soo Shin1,* , So-Young Lee1 , Yang Gyun Kim2 , Sang Ho Lee2 , Ju Young Moon2 , Kyung Hwan Jeong3 , Hyeon Seok Hwang3 , Shin Young Ahn4 , Hong Joo Lee5 , Dong-Young Lee6 , Eun-Jung Ko7 , Hye Jeong Cho8 , Dong Ho Yang1 , Hye Yun Jeong1
1Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
2Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
3Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
4Division of Nephrology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
5Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Republic of Korea
6Division of Nephrology, Department of Internal Medicine, VHS Medical Center, Seoul, Republic of Korea
7Department of Internal Medicine, Sa-lang Hospital, Ansan, Republic of Korea
8Division of Nephrology, Department of Internal Medicine, International Naeun Hospital, Anyang, Republic of Korea
Correspondence to: Hye Yun Jeong
Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea. E-mail: heun-j@hanmail.net
Dong Ho Yang
Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea. E-mail: dhyang@cha.ac.kr
*Yu Ho Lee and Yoon Soo Shin contributed equally to the work as co-first authors.

Edited by Young-Ki Lee, Hallym University, Seoul, Republic of Korea
Received: August 1, 2019; Revised: December 4, 2019; Accepted: December 4, 2019; Published online: March 31, 2020.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Online hemodiafiltration (OL-HDF) offers considerable advantages in clearance of molecules of various sizes. However, evidence of clinical effects of OL-HDF is scarce in Korea. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF.
Methods: Adult patients with end-stage renal disease undergoing hemodialysis (HD) were prospectively enrolled in a K-cohort (CRIS no. KCT0003281) from 6 tertiary hospitals in South Korea. We recruited 435 patients, 339 of whom were on HD at enrollment. One hundred eighty-two patients were followed for more than 24 months. Among them, 44 were switched to OL-HDF for more than 12 months without conversion to HD. We used a paired t test to compare baseline and 24-month follow-up results.
Results: The mean age of the subjects was 61.2 ± 12.2 years, and 62.6% were male. The baseline hemoglobin level was not significantly different between HD and OL-HDF group (10.61 ± 1.15 vs. 10.46 ± 1.03 g/dL, P = 0.437). However, the baseline serum protein and albumin levels were significantly lower in the OL-HDF group (6.82 ± 0.49 vs. 6.59 ± 0.48 g/dL, P = 0.006; 3.93 ± 0.28 vs. 3.73 ± 0.29 g/dL, P < 0.001). In patients switched to OL-HDF, levels of hemoglobin and serum albumin significantly increased (10.46 ± 1.03 vs. 11.08 ± 0.82 g/dL, P = 0.001; 3.73 ± 0.29 vs. 3.87 ± 0.30 g/dL, P = 0.001). The normalized protein catabolic rate decreased after 24 months, but the change was not significant (1.07 ± 0.25 vs. 1.03 ± 0.21 g/kg/day, P = 0.433). Although the dose of erythropoiesis-stimulating agent was lower in patients who converted to HDF, it was not significantly different (-115.7 ± 189.7 vs. -170.5 ± 257.1 P = 0.206).
Conclusion: OL-HDF treatment over more than 12 months was associated with no harmful effects on anemia and nutritional status.
Keywords: Anemia, Dialysis, Kidney failure, chronic, Hemodiafiltration, Nutritional status


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