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Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial

BACKGROUND: Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight...

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Detalles Bibliográficos
Autores principales: Pecoits-Filho, Roberto, Larkin, John, Poli-de-Figueiredo, Carlos Eduardo, Cuvello-Neto, Américo Lourenço, Barra, Ana Beatriz Lesqueves, Gonçalves, Priscila Bezerra, Sheth, Shimul, Guedes, Murilo, Han, Maggie, Calice-Silva, Viviane, de Castro, Manuel Carlos Martins, Kotanko, Peter, de Moraes, Thyago Proenca, Raimann, Jochen G, Canziani, Maria Eugenia F
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160948/
https://www.ncbi.nlm.nih.gov/pubmed/33160281
http://dx.doi.org/10.1093/ndt/gfaa173
Descripción
Sumario:BACKGROUND: Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight removal and studies suggest better clinical/patient-reported outcomes compared with hemodialysis (HD). METHODS: HDFIT was a randomized controlled trial at 13 clinics in Brazil that aimed to investigate the effects of HDF on measured PA (step counts) as a primary outcome. Stable HD patients (vintage 3–24 months) were randomized to receive HDF or high-flux HD. Treatment effect of HDF on the primary outcome from baseline to 3 and 6 months was estimated using a linear mixed-effects model. RESULTS: We randomized 195 patients (HDF 97; HD 98) between August 2016 and October 2017. Despite the achievement of a high convective volume in the majority of sessions and a positive impact on solute removal, the treatment effect HDF on the primary outcome was +538 [95% confidence interval (CI) −330 to 1407] steps/24 h after dialysis compared with HD, and was not statistically significant. Despite a lack of statistical significance, the observed size of the treatment effect was modest and driven by steps taken between 1.5 and 24.0 h after dialysis, in particular between 20 and 24 h (+197 steps; 95% CI −95 to 488). CONCLUSIONS: HDF did not have a statistically significant treatment effect on PA 24 h following dialysis, albeit effect sizes may be clinically meaningful and deserve further investigation.