HFR A-equilibrium on Cardiovascular Stability

Online hemodiafiltration (OL-HDF) has been recently associated with better patient survival in comparison with standard hemodialysis in some large observational studies (Canaud et al, KI, 2006; Vilar et al, CJASN , 2009) supporting the hypothesis that convection can improve patients outcomes. Moreover, it has been demonstrated in randomized controlled trials (Locatelli et al, Journal American Society of Nephrology, 2010) that OL-HDF significantly reduced the frequency of intradialytic hypotension. Nonetheless, the associated comorbidities and ageing of dialysis population require further devices able to improve treatment tolerance. Among these tools, the sodium profiling and biofeedback system seem to be promising to accomplish this task. But the correct intradialytic sodium balance is still far away today to be easily achieved. The use of an automated adaptive system dialysis to the sodium profiling has been investigated in a feasibility trial (Colì et al International Journal Artificial Organs, 2003). They also investigated the impact of such a device on treatment tolerance.

The aim of this randomized multinational multicenter controlled trial is to evaluate the impact of sodium profiling applied to a endogenous hemodiafiltration technique on the intradialytic cardiovascular stability in comparison to standard no profiled endogenous hemodiafiltration.

Inclusion criteria

• Patients with more than 30% of dialysis complicated by hypotension
• age between 18 and 85 yers
• time on dialysis greater than 6 months
• residual creatinine clearance less than 2 ml/min/1.73 m2
• native fistula or central venous catheter with blood flow rate greater than 250 ml/min

Exclusion criteria

• Life expectancy less than 1 year
• solid active neoplasm
• pregnancy
• major event in the previous 3 months (ictus, myocardial infarction, cachexia)