Impacts of Short Daily Hemodiafiltration on Hypervolemia in ESRD: A Cross-Sectional Study

Background: Hypervolemia is a common issue in patients with end-stage renal disease, contributing to significant morbidity such as hypertension and heart failure, along with elevated rates of hospitalization and mortality. Conventional thrice-weekly hemodialysis often results in fluid overload due to extended gaps between treatment sessions. This study presents a cross-sectional analysis of the effectiveness of short daily hemodiafiltration (SDHDF) in managing hypervolemia within a single-center chronic dialysis population. Methods: Bioimpedance spectroscopy (BIS) was utilized as a non-invasive technique (BCM - FMC) to assess fluid status in 69 patients (40 males; average age 66.4 ± 14.1 years; 43% with diabetes), undergoing short daily high-volume hemodiafiltration (2 hours duration, six times a week; 66% with arteriovenous fistula, 22% with PermCath and 12% with arteriovenous graft; HDF-IQ BBraun machines, Xevonta Hi23 dialyzer, Aquaboss Osmosis). The primary endpoints included pre-dialysis volume status as measured by BIS, along with pre-dialysis blood pressure readings, and hospitalization and mortality rates over the course of 2024. At the time of the measurements patients had been stable on daily HDF for at least three months. Results: The analysis revealed that in-center SDHDF patients had an average pre-HDF fluid overload of 0.86 ± 1.6 L (mean ± SD). Among the patients, 33% demonstrated fluid overload, 57% were normally hydrated and 10% were fluid depleted. Only 26% of the total patient cohort presented with hypertension. Evaluating fluid status, 35% of fluid-overloaded patients were hypertensive, while 65% maintained normotensive status and none were hypotensive. In this daily in-center HDF program, now in its second year, the hospitalization rate for the first year was recorded at 0.7 per patient-year, with mortality rate of 4.3%. Conclusion: These findings strongly support the efficacy of daily hemodiafiltration in addressing hypervolemia. The higher frequency of treatment promotes effective fluid balance, improves blood pressure control, and leads to better overall health outcomes, such as low hospitalization and high survival rates. As healthcare systems increasingly prioritize dialysis patient-centered care, integrating more frequent hemodialysis options may become a vital strategy for optimizing treatment.