International Urology and Nephrology

, Volume 45, Issue 5, pp 1389–1396 | Cite as

Effects of high efficiency post-dilution on-line hemodiafiltration or conventional hemodialysis on residual renal function and left ventricular hypertrophy

  • Helmut Schiffl
  • Susanne M. Lang
  • Rainald Fischer
Nephrology - Original Paper



Residual renal function (RRF) contributes to dialysis adequacy, quality of life and survival of hemodialysis patients. There is an ongoing debate whether better preservation of residual renal function is the result of chronic fluid volume overload. Our prospective investigation analyzed the effects of different dialytic therapies on RRF and left ventricular hypertrophy, which may be considered—at least in part—a surrogate marker of chronic fluid overload.


Two cohorts of end-stage renal disease patients initiating renal replacement therapy (high efficiency post-dilution on-line hemodiafiltration (HDF) in 58 patients, conventional hemodialysis (HD) in 60 patients) were prospectively followed up. RRF was determined at baseline, 12 and 24 months, left ventricular mass index (LVMI) at baseline and after 24 months.


Demographic and renal characteristics, medication or exposure to nephrotoxins were comparable among the two cohorts of patients. RRF declined in all patients throughout the 2-year study period. In HDF patients, the decline was less pronounced (28 %) than in conventional HD patients (68 %). More patients undergoing HD received cardio- and renoprotective antihypertensive drugs. CRP levels were significantly higher in conventional HD. Hypotensive episodes were fewer in HDF. LVMI decreased in 90 % of HDF compared to only 25 %of HD patients.


Our data clearly indicate that better preservation of RRF by high efficiency hemodiafiltration is not associated with left ventricular hypertrophy.


Residual renal function Left ventricular hypertrophy On-line hemodiafiltration Conventional hemodialysis 


  1. 1.
    Brener ZZ, Thijssen S, Kotanko P, Kuhlmann MK, Bergman M, Winchester JF, Levin NW (2011) The impact of residual renal function on hospitalization and mortality in incident hemodialysis patients. Blood Purif 31:243–251PubMedCrossRefGoogle Scholar
  2. 2.
    Shafi T, Jaar BG, Plantinga LC, Fink NE, Sadler JH, Parekh RS, Powe NR, Coresh J (2010) Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the choices for healthy outcomes in caring for end-stage renal disease (CHOICE) study. Am J Kidney Dis 56:348–358PubMedCrossRefGoogle Scholar
  3. 3.
    Shemin D, Bostom AG, Laliberty P, Dworkin LD (2001) Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis 38:85–90PubMedCrossRefGoogle Scholar
  4. 4.
    Vilar E, Wellsted D, Chandna SM, Greenwood RN, Farrington K (2009) Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant 24:2502–2510PubMedCrossRefGoogle Scholar
  5. 5.
    National Kidney Foundation (2006) KDOQI Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 48:S2–S90CrossRefGoogle Scholar
  6. 6.
    Lysaght MJ, Vonesh EF, Gotch F, Ibels L, Keen M, Lindholm B, Nolph KD, Pollock CA, Prowant B, Farrell PC (1991) The influence of dialysis treatment modality on the decline of remaining renal function. ASAIO Trans 37:598–604PubMedGoogle Scholar
  7. 7.
    Horinek A, Misra M (2004) Does residual renal function decline more rapidly in hemodialysis than in peritoneal dialysis? How good is the evidence? Adv Perit Dial 20:137–140PubMedGoogle Scholar
  8. 8.
    Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT (2002) Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 62:1046–1053PubMedCrossRefGoogle Scholar
  9. 9.
    Schiffl H, Lang SM, Fischer R (2002) Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients. Nephrol Dial Transplant 17:1814–1818PubMedCrossRefGoogle Scholar
  10. 10.
    Lang SM, Bergner A, Topfer M, Schiffl H (2001) Preservation of residual renal function in dialysis patients: effects of dialysis-technique-related factors. Perit Dial Int 21:52–57PubMedGoogle Scholar
  11. 11.
    Hartmann J, Fricke H, Schiffl H (1997) Biocompatible membranes preserve residual renal function in patients undergoing regular hemodialysis. Am J Kidney Dis 30:366–373PubMedCrossRefGoogle Scholar
  12. 12.
    McKane W, Chandna SM, Tattersall JE, Greenwood RN, Farrington K (2002) Identical decline of residual renal function in high-flux biocompatible hemodialysis and CAPD. Kidney Int 61:256–265PubMedCrossRefGoogle Scholar
  13. 13.
    Hyodo T, Koutoku N (2011) Preservation of residual renal function with HDF. Contrib Nephrol 168:204–212PubMedCrossRefGoogle Scholar
  14. 14.
    Covic A, Goldsmith DJ, Georgescu G, Venning MC, Ackrill P (1996) Echocardiographic findings in long-term, long-hour hemodialysis patients. Clin Nephrol 45:104–110PubMedGoogle Scholar
  15. 15.
    Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE (2000) Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J Am Soc Nephrol 11:912–916PubMedGoogle Scholar
  16. 16.
    Paoletti E, Specchia C, Di MG, Bellino D, Damasio B, Cassottana P, Cannella G (2004) The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey. Nephrol Dial Transplant 19:1829–1834PubMedCrossRefGoogle Scholar
  17. 17.
    Haag-Weber M (2008) The impact of residual renal function on survival. Nephrol Dial Transplant 23:2123–2126PubMedCrossRefGoogle Scholar
  18. 18.
    Canaud B (2008) Residual renal function: the delicate balance between benefits and risks. Nephrol Dial Transplant 23:1801–1805PubMedCrossRefGoogle Scholar
  19. 19.
    Gunal AI, Kirciman E, Guler M, Yavuzkir M, Celiker H (2004) Should the preservation of residual renal function cost volume overload and its consequence left ventricular hypertrophy in new hemodialysis patients? Ren Fail 26:405–409PubMedCrossRefGoogle Scholar
  20. 20.
    European Best Practice Guidelines on Haemodialysis.(Part 1) (2002) Measurement of renal function, when to refer and when to start dialysis. Nephrol Dial Transplant 17(suppl 7):7–15Google Scholar
  21. 21.
    Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083PubMedCrossRefGoogle Scholar
  22. 22.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458PubMedCrossRefGoogle Scholar
  23. 23.
    Shin SK, Noh H, Kang SW, Seo BJ, Lee IH, Song HY, Choi KH, Ha SK, Lee HY, Han DS (1999) Risk factors influencing the decline of residual renal function in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 19:138–142PubMedGoogle Scholar
  24. 24.
    Vaslaki LR, Berta K, Major L, Weber V, Weber C, Wojke R, Passlick-Deetjen J, Falkenhagen D (2005) On-line hemodiafiltration does not induce inflammatory response in end-stage renal disease patients: results from a multicenter cross-over study. Artif Organs 29:406–412PubMedCrossRefGoogle Scholar
  25. 25.
    Glassock RJ, Pecoits-Filho R, Barberato SH (2009) Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol 4(Suppl 1):S79–S91PubMedCrossRefGoogle Scholar
  26. 26.
    Ardeleanu S, Panaghiu L, Prisada O, Sascau R, Voroneanu L, Hogas S, Mardare N, Covic A (2011) Regression of left ventricular hypertrophy in hemodialyzed patients is possible: a follow-up study. Int Urol Nephrol 43:1161–1169PubMedCrossRefGoogle Scholar
  27. 27.
    Kong CH, Farrington K (2003) Determinants of left ventricular hypertrophy and its progression in high-flux haemodialysis. Blood Purif 21:163–169PubMedCrossRefGoogle Scholar
  28. 28.
    Palmieri V, Tracy RP, Roman MJ, Liu JE, Best LG, Bella JN, Robbins DC, Howard BV, Devereux RB (2003) Relation of left ventricular hypertrophy to inflammation and albuminuria in adults with type 2 diabetes: the strong heart study. Diabetes Care 26:2764–2769PubMedCrossRefGoogle Scholar
  29. 29.
    Masiha S, Sundstrom J, Lind L (2012) Inflammatory markers are associated with left ventricular hypertrophy and diastolic dysfunction in a population-based sample of elderly men and women. J Hum Hypertens doi: 10.1038/jhh.201.113
  30. 30.
    Ohtake T, Oka M, Ishioka K, Honda K, Mochida Y, Maesato K, Moriya H, Hidaka S, Kobayashi S (2012) Cardiovascular protective effects of on-line hemodiafiltration: comparison with conventional hemodialysis. Ther Apher Dial 16:181–188PubMedCrossRefGoogle Scholar
  31. 31.
    Alvestrand A, Ledebo I, Hagerman I, Wingren K, Mattsson E, Qureshi AR, Gutierrez A (2011) Left ventricular hypertrophy in incident dialysis patients randomized to treatment with hemofiltration or hemodialysis: results from the ProFil study. Blood Purif 32:21–29PubMedCrossRefGoogle Scholar
  32. 32.
    Schmid H, Schiffl H (2012) Hemodiafiltration and survival of end-stage renal disease patients: the long journey goes on. Int Urol Nephrol 44:1435–1440PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Helmut Schiffl
    • 1
    • 2
  • Susanne M. Lang
    • 3
  • Rainald Fischer
    • 2
  1. 1.KfH Nierenzentrum München-LaimMunichGermany
  2. 2.Department of Internal Medicine, University Hospital Campus-InnenstadtUniversity of MunichMunichGermany
  3. 3.Medizinische Klinik 2, SRH Wald-Klinikum GeraGeraGermany

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