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Titolo	Hemofiltration and Hemodiafiltration Reduce Intradialytic Hypotension in ESRD
Autore	Francesco Locatelli,* Paolo Altieri, Simeone Andrulli,* Piergiorgio Bolasco,± Giovanna Sau, Luciano A. Pedrini,§ Carlo Basile, Salvatore David,¶ Mariano Feriani, Giovanni Montagna, Biagio Raffaele Di Iorio,±± Bruno Memoli,§§ Raffaella Cravero, Giovanni Battaglia,¶¶ and Carmine Zoccali* - Departments of Nephrology and Dialysis, Ospedale Alessandro Manzoni, Lecco, Italy; Departments of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Cagliari, Italy; ±Departments of Nephrology and Dialysis, Dipartimento territoriale ASL 8, Cagliari, Italy; §Departments of Nephrology and Dialysis, Ospedale Bolognini, Seriate, Italy; Departments of Nephrology and Dialysis, Ospedale F. Miulli, Acquaviva delle Fonti, Italy; ¶Departments of Nephrology and Dialysis, Ospedale Maggiore, Parma, Italy; Departments of Nephrology and Dialysis, Ospedale dell?Angelo, Mestre, Italy; Departments of Nephrology and Dialysis, Fondazione Maugeri IRCCS, Pavia, Italy; ±±Departments of Nephrology and Dialysis, Ospedale Agostino Landolfi, Solofra, Italy; §§Departments of Nephrology and Dialysis, Universita` Federico II, Napoli, Italy; Departments of Nephrology and Dialysis, Ospedale degli Infermi, Biella, Italy; ¶¶Departments of Nephrology and Dialysis, Ospedale S. Marta S. Venera, Acireale, Italy; and **Departments of Nephrology and Dialysis, Centro di Fisiologia Clinica, Azienda Ospedaliera ?Bianchi Melacrino Morelli,? Reggio Calabria, Italy
Referenza	J Am Soc Nephrol 2010; doi: 10.1681/ASN.2010030280
Contenuto	Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. Inthis multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n 70), online predilution hemofiltration (HF; n 36), or online predilution hemodiafiltration (HDF; n 40). The primary end point was the frequency of intradialytic symptomatic hypotension (ISH). Compared with the run-in period, the frequency of sessions with ISH during the evaluation period increased for HD (7.1 to 7.9%) and decreased for both HF (9.8 to 8.0%) and HDF (10.6 to 5.2%) (P 0.001). Mean predialysis systolic BP increased by 4.2 mmHg among those who were assigned to HDF compared with decreases of 0.6 and 1.8 mmHg among those who were assigned to HD and HF, respectively (P 0.038). Multivariate logistic regression demonstrated significant risk reductions in ISH for both HF (odds ratio 0.69; 95% confidence interval 0.51 to 0.92) and HDF (odds ratio 0.46, 95% confidence interval 0.33 to 0.63). There was a trend toward higher dropout for those who were assigned to HF (P 0.107). In conclusion, compared with conventional HD, convective therapies (HDF and HF) reduce ISH in long-term dialysis patients.
Data	13.09.2010

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