Uremic Toxin Removal and Hemodynamics in Long-hour Hemodialysis and Hemodiafiltration

Uremic Toxin Removal and Hemodynamics in Long-hour Hemodialysis and Hemodiafiltration; a Randomized Cross-over Study

Rationale: The mortality of end-stage renal disease (ESRD) patients on dialysis remains high. This may at least be partly due to the insufficient removal of (especially protein-bound) uremic toxins which have been associated with cardiovascular morbidity and mortality. It is unknown whether the combination of long-hour haemodialysis (HD) with convection increases the removal of these toxins. Long-hour HD and long-hour haemodiafiltration (HDF) may also improve haemodynamic stability which is an important factor in treatment quality. The investigators aim to study the removal of uremic toxins in long-hour HD and HDF and to compare the haemodynamics between 4-hour and 8-hour HD and HDF.

Objectives: The primary aim is to study the removal of (especially protein-bound) uremic toxins in 4-hour and 8-hour HD and HDF. A secondary aim is to compare the haemodynamic response between 4-hour and 8-hour HD and HDF.

Inclusion Criteria:

• prevalent conventional HD patients
• AV-fistula enabling double-needle vascular access with blood flow rate of at least 350 ml/min
• informed consent
• age more than 18 years

Exclusion Criteria:

• withdrawal of consent
• acute intercurrent illness (infection, malignancy, cardiovascular event, uncontrolled diabetes)