Mixed hemodiafiltration reduces erythropoiesis stimulating agents requirement in dialysis patients: a prospective random
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ORIGINAL ARTICLE
Mixed hemodiafiltration reduces erythropoiesis stimulating agents requirement in dialysis patients: a prospective randomized study Luciano A. Pedrini1 · Mario Comelli2 · Pio Ruggiero1 · Annalisa Feliciani1 · Vania Manfrini1 · Giorgio Cozzi1 · Angelo Castellano1 · Mauro Pezzotta1 · Guido Gatti1 · Marta Arazzi1 · Laura Auriemma3 · Attilio di Benedetto4 · Stefano Stuard5 Received: 18 October 2019 / Accepted: 31 January 2020 © Italian Society of Nephrology 2020
Abstract Background Improved responsiveness to erythropoiesis stimulating agents (ESAs) in patients on on-line post-dilution hemodiafiltration (Post-HDF) compared with conventional hemodialysis (HD) was reported by some authors but challenged by others. This prospective, cross-over randomized study tested the hypothesis that an alternative infusion modality of HDF, mixed-dilution HDF (Mixed HDF), could further reduce ESAs requirement in dialysis patients compared to the traditional Post-HDF. Methods One-hundred-twenty prevalent patients from 6 Dialysis Centers were randomly assigned to two six-months treatment sequences: A–B and B–A (A, Mixed HDF; B, Post-HDF). Primary outcome was comparative evaluation of ESA (darbepoetin alfa) requirement and ESA resistance. Treatments efficiency, iron and vitamins status, inflammation and nutrition parameters were monitored. Results In sequence A, darbepoetin requirement decreased during Mixed HDF from 29.5 to 23.7 µg/month and increased significantly during Post-HDF (32.3 µg/month at 6th month) while, in sequence B, it increased during Post-HDF from 38.2 to 43.7 µg/month and decreased during Mixed HDF (23.9 µg/month at 6th month). Overall, EPO doses at 6 months on Mixed and Post-HDF were 23.8 and 38.4 µg/month, respectively, P
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