Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly

Kidney Int. 2017 Jun;91(6):1495-1509. doi: 10.1016/j.kint.2017.01.013. Epub 2017 Mar 18.


Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30-day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux hemodialysis and online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a statistical unit according to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of metabolic bone disease biomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux hemodialysis in the elderly.

Keywords: cardiovascular risk biomarkers; chronic kidney disease; hemodiafiltration; intradialytic tolerance; mortality; safety.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Female
  • France
  • Geriatric Assessment
  • Hemodiafiltration / adverse effects
  • Hemodiafiltration / methods*
  • Hemodiafiltration / mortality
  • Hospitalization
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / physiopathology*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / mortality
  • Kidney Diseases / physiopathology
  • Kidney Diseases / therapy*
  • Male
  • Prospective Studies
  • Quality of Life
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods*
  • Renal Dialysis / mortality
  • Time Factors
  • Treatment Outcome