#616 First 100 patients undergoing nocturnal every-other-day online hemodiafiltration: clinical outcomes and patient and technique survival

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Abstract Background and Aims Patients with end-stage renal disease face substantial morbidity and mortality, often driven by cardiovascular complications. Advances in dialysis modalities aim to improve patient outcomes. This single-center observational study evaluates the clinical impact of nocturnal every-other-day online hemodiafiltration (OL-HDF) in 100 patients, with a focus on patient and technique survival, clinical parameters, and treatment tolerability over a mean follow-up of 36.1 ± 34 months. Method Participants underwent nocturnal OL-HDF sessions, extending session duration from 4–5 hours thrice weekly to 7–8 hours every other day. Key parameters, including dialysis adequacy (Kt/V), blood pressure, calcium–phosphate balance, anemia management, and nutritional status, were assessed quarterly. Patient survival, technique survival, and reasons for discontinuation were analyzed, with kidney transplantation as a primary endpoint. Results Clinical outcomes improved significantly. The convective volume increased from 27.1 ± 4.6 L at baseline to 48.1 ± 6.4 L at 24 months. Antihypertensive and phosphate binder usage decreased markedly from 56.7% to 28.3% and 76.7% to 3.3%, respectively, while phosphorus supplementation was required in 58.3% of patients to prevent hypophosphatemia. Iron and erythropoiesis-stimulating agent doses were also reduced. Nutritional and biochemical markers, including normalized protein catabolic rate and serum albumin, improved or remained stable. Patient survival was 94% at the end of follow-up, with higher rates among transplant-listed patients (98.1% vs. 84.6% at 24 months). Technique survival was primarily limited by kidney transplantation, the most common reason for discontinuation (78.4%). Mortality, driven by comorbidities, was the leading cause of discontinuation in non-listed patients. Conclusion Nocturnal OL-HDF is a well-tolerated, high-efficiency regimen offering significant improvements in clinical and biochemical outcomes. By reducing cardiovascular and metabolic risks, it supports patient rehabilitation and quality of life. Long-term multicenter studies are needed to confirm these findings and explore broader implementation.

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