Comparison of survival for super high-flux hemodialysis (SHF-HD) with high albumin leakage versus online hemodiafiltration or SHF-HD with low albumin leakage: the SUPERB study

Abstract

Abstract Background Survival is equivalent between super high-flux hemodialysis (SHF-HD) and online hemodiafiltration (OHDF) with similar albumin leakage. According to the 2013 Japanese dialyzer performance classification, survival on HD is optimal when a type II dialyzer (β2-microglobulin clearance ≥ 70 mL/min) is used. Here, we investigated whether survival could be improved by SHF-HD using a type II-b dialyzer (sieving coefficient for albumin ≥ 0.03) with high albumin leakage compared with OHDF or SHF-HD using a type II-a dialyzer (sieving coefficient for albumin < 0.03) with low albumin leakage. Methods This 3-year retrospective observational propensity score-matched study included 738 patients receiving SHF-HD (n = 310) or OHDF (n = 428) with a type II dialyzer at our institution between April 1 and July 1, 2017. Three-year all-cause mortality was compared for SHF-HD with high estimated albumin leakage (EAL) versus OHDF and SHF-HD with low EAL. Kaplan–Meier survival curves were compared using the log-rank test and hazard ratios were calculated by Cox regression analysis. Results Mortality in SHF-HD with high EAL was significantly lower than OHDF with low EAL (each n = 52 after matching; P = 0.007, log-rank test). All the dialyzers used a polyethersulfone (PES) membrane, whereas none of the hemodiafilters had a PES membrane. In SHF-HD, mortality was significantly lower when EAL was ≥ 3.0 g/session than when EAL was < 3.0 g/session (each n = 115 after matching, P = 0.004, log-rank test) and when the dialyzer used was type II-b rather than type II-a (each n = 133 after matching, P = 0.001, log-rank test). Conclusions These findings suggest that survival is better on SHF-HD using a type II-b dialyzer with high albumin leakage than on OHDF with low albumin leakage or SHF-HD using a type II-a dialyzers. The PES used in the type II-b dialyzer may also have a beneficial effect on survival.