Impact of high-volume haemodiafiltration on nutrition and quality of life in patients with end-stage renal disease

Background: Haemodiafiltration (HDF) provides better removal of middle-molecular-weight toxins, improving patient outcomes, including quality of life (QoL) and nutritional status, compared to standard haemodialysis. The present study aimed to evaluate the clinical impact of high-convection volume in HDF on QoL and nutritional status in patients undergoing twice-weekly HDF. Methods: A prospective observational study was conducted amongst patients undergoing HDF from January to July 2024. HDF was performed twice-weekly. Data collected during dialysis included patient demographics, comorbidities, dialysis duration, body surface area and medical history. Length of time on HDF, laboratory measurements, dialysis-related data and episodes of infection and hospital admissions were noted. Results: Out of the 40 patients included, the majority ( n = 28, 70%) were men. The mean length of time on HDF was 39.6 months. The average haemoglobin level was 10.8 ± 1.5 g/dL. The target volume of ≥23 L per session for high-dose convection was achieved in 25 (62.5%) of delivered HDF sessions. The majority of patients from both groups were well nourished (effective convective volume [ECV] ≥23 L; n = 15 and ECV <23 L; n = 9). Overall health and sleep quality improved over 6 months, with no significant differences at 3 or 6 months. Patients with a shorter dialysis vintage (≤36 months) had slightly better health-related-QoL and sleep-related QoL scores. Conclusions: This study on dialysis-dependent end-stage renal disease patients reveals that high-volume HDF with a convection volume of ≥23 L offers potential nutritional and QoL benefits, even though achieving optimal convection volume is challenging.