Jaques David A, Chhabra Roohi, Khatri Priyanka, Davenport Andrew
Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland.
UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.
Artif Organs. 2025 Feb;49(2):300-309. doi: 10.1111/aor.14883. Epub 2024 Oct 8.
Hyperkalemia is frequently encountered and associated with cardio-vascular mortality in chronic hemodialysis (HD) patients. While online hemodiafiltration (OL-HDF) is thought to offer clinical benefit over high-flux HD, the impact of convective clearance on intra-dialytic potassium removal is unknown.
Chronic dialysis patients undergoing outpatient HD or OL-HDF at a single center attached to a university hospital were recruited in a prospective observational study. Spent dialysate along with clinical and biological variables were collected during a single mid-week session.
We included 141 patients, with 21 treated with HD and 120 with OL-HDF. Mean age was 65.7 ± 15.6 years with 87 (61.7%) men. Mean intra-dialytic potassium removal was 69.9 ± 34.2 mmol. Patients on OL-HDF and HD have similar intra-dialytic potassium removal, with mean values of 69.1 ± 34.2 and 74.3 ± 35.0, respectively. In multivariate analysis, factors associated with intra-dialytic potassium removal were (decreasing order of effect size): dialysate potassium (β -15.5, p < 0.001), pre-HD serum potassium (β 9.1, p < 0.001), and session time (β 7.8, p = 0.003). In OL-HDF patients, substitution flow was not associated with potassium removal.
In chronic dialysis patients, convective therapy provided by OL-HDF does not affect potassium removal when compared with high-flux HD. Moreover, the importance of convective volume is not associated with potassium clearance in OL-HDF. Overall, session length and serum-to-dialysate potassium gradient are the main determinants of potassium clearance regardless of dialysis modality. Those results should inform clinicians on the optimal therapy in chronic dialysis patients in the era of OL-HDF.
高钾血症在慢性血液透析（HD）患者中经常出现，并与心血管死亡率相关。虽然在线血液透析滤过（OL-HDF）被认为比高通量HD具有临床益处，但对流清除对透析期间钾清除的影响尚不清楚。
在一项前瞻性观察性研究中，招募了在一所大学医院附属的单一中心接受门诊HD或OL-HDF的慢性透析患者。在一周中的单个时段收集用过的透析液以及临床和生物学变量。
我们纳入了141例患者，其中21例接受HD治疗，120例接受OL-HDF治疗。平均年龄为65.7±15.6岁，男性87例（61.7%）。透析期间平均钾清除量为69.9±34.2 mmol。接受OL-HDF和HD治疗的患者透析期间钾清除量相似，平均值分别为69.1±34.2和74.3±35.0。在多变量分析中，与透析期间钾清除相关的因素（效应大小降序排列）为：透析液钾（β -15.5，p<0.001）、HD前血清钾（β 9.1，p<0.001）和治疗时间（β 7.8，p = 0.003）。在OL-HDF患者中，置换流量与钾清除无关。
在慢性透析患者中，与高通量HD相比，OL-HDF提供的对流治疗不影响钾清除。此外，对流体积的重要性与OL-HDF中的钾清除无关。总体而言，无论透析方式如何，治疗时间和血清与透析液之间的钾梯度是钾清除的主要决定因素。这些结果应为临床医生在OL-HDF时代对慢性透析患者的最佳治疗提供参考。
