Conventional Hemodialysis vs. Postdilutional Hemofiltration as Initial Treatment in Incident Patients: A Comparative Analysis

Background: While Hemodialysis (HD) is commonly used as the initial modality in incident Kidney Replacement Therapy (KRT) patients, the application of Hemofiltration (HF) is less documented. This study aimed to compare the performance and safety of post-dilutional HF versus HD as the first therapy in patients initiating KRT. Methods: We conducted a retrospective, single-center study including all patients who initiated KRT between January 2024 and April 2025. Patients received their initial modality based on institutional protocols. For hemodialysis, a fixed session time was calculated to obtain a urea reduction rate (URR) of less than 30% according to the dialyzer clearance and the patient's body water, while for hemofiltration a fixed substitution rate was calculated according to a necessary convective clearance to obtain a URR less than 30%. Pre and post session biochemical values were collected. The presence of intradialytic morbid events —such as dizziness, nausea, cramps, arrhythmias, hypotension or cardiac arrest were considered adverse events. Results: 40 patients were included, 22 treated with HD and 18 with post-dilutional HF. There were no significant differences in URR between both groups. Post-dialysis biochemical parameters showed differences only in bicarbonate and serum potassium (Table 1). The proportion of patients achieving clinical targets (post-K < 5 mmol/L, post-HCO3 ≥ 22 mmol/L, Kt/V ≥ 1.2) was similar. No differences in adverse events were observed. Conclusion: In patients initiating KRT, HF did not show significant differences in efficacy and safety compared to conventional hemodialysis. These findings suggest HF as an alternative initial KRT modality.