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NCT ID: NCT01877499 Completed - Clinical trials for End-stage Renal Disease

Can High Convection Volumes be Achieved in Each Patient During Online Post-dilution Hemodiafiltration?

Start date: March 28, 2013
Phase: N/A
Study type: Observational

Two recent randomized controlled trials (RCT) on online hemodiafiltration (HDF) did not show a treatment effect on patient survival when compared with low‐ or high‐flux hemodialysis. Interestingly, post‐hoc (on treatment) analyses from both trials unequivocally showed reduced mortality in the patient group achieving the highest convection volumes. Moreover, a third trial recently found a significant 30% decrease in mortality when HDF was applied with a mean convection volume of 23.7 L per session, which was somewhat higher than the average volumes reached in the aforementioned trials. Altogether, these findings support the concept of a dose-response effect, in which a minimally delivered convection volume is required in order to show a survival benefit. Hence, the question arises whether high convection volumes are achievable in the majority of patients. The aim of this study is thus to test the following hypothesis: high‐volume (>22 liters per treatment) post-dilution on‐line hemodiafiltration (HDF) is achievable in the majority (>75%) of patients treated with chronic intermittent hemodialysis. This will be done through the use of a dedicated standardized protocol, in which the three most important determinants of convection volume will be successively optimized: treatment time, blood flow rate and filtration fraction.