In hemodialysis (HD) patients, poor health-related quality of life (HRQoL) is frequent and it is associated with adverse outcome [1].

It is well known that HRQoL and nutritional status are strictly linked [2]. Whether amelioration of chronic inflammation and improvement of nutritional status modifies HRQoL is ill-defined.

Hemodiafiltration with  endogenous reinfusion (HFR) is an alternative dialysis technique (fig.1) that combining diffusion, convection and absorption, reduces inflammation burden and malnutrition [3,4] but it has never been evaluated the effect on HRQoL.


We designed a cross-sectional multicentre study in order to compare the HRQoL in patients treated with HFR versus BHD.

We enrolled adult patients treated for at least 6 months HFR, with life expectancy greater than six months and without remarkable cognitive deficit.

The recruited patients in HFR were matched for age, gender, dialytic vintage and performance in activities of daily living (Barthel index) with BHD treated patients.

Demographic, clinical, laboratory and treatment data were collected and SF-36 questionnaire for the assessment of QoL was administered at baseline.


One hundred fourteen patients were enrolled (age 65.4±13.5 years; dialysis vintage 5.4 (3.3-10.3) years; 53%males) from 18 dialysis non-profit centres in central and southern Italy (figure 1).

As result of matching,  no difference in age, gender , dialytic age and Barthel index was found between HFR and BHD patients.  KTV, hemoglobin and serum albumin were similar between the two treatment groups.

In HFR patients we observed higher values of SF-36 physical component score than BHD patients(p=0.048; figure 2), whereas no significant difference emerged in the mental component score (p=0.698; figure 3). As described in figure 4, HFR patients had a better Physical Functioning and Role Physical, whereras no differences of the other SF-36 items was found between HFR and BHD (figure 2).


HFR is associated with a better physical component of HRQoL than BHD, independently of age, gender, dialysis vintage and invalidity score. Whether these finding translates into a survival benefit must be assessed in longitudinal study.


  1. Evans RW, Manninen DL, Garrison LP Jr et al. The quality of life of patientswith end-stage renal disease. N Engl J Med 1985; 312:553-9.
  2. Feroze U,Noori N, Kovesdy CB, et al. Quality-of-Life and Mortality in Hemodialysis Patients: Roles of Race and Nutritional Status. Clin J Am Soc Nephrol 2011; 6:1100-11.
  3. Panichi V, Manca-Rizza G, Paoletti S, et al. Effects on inflammatory and nutritional markers of haemodiafiltration with online regeneration of ultrafiltrate (HFR) vs online haemodiafiltration: a cross-over randomized multicentre trial. Nephrol Dial Transplant. 2006;21:756-62.
  4. Borrelli S, Minutolo R, De Nicola L, et al.Intradialytic Changes of Plasma Amino Acids Levels: Effect of Hemodiafiltration with Endogenous Reinfusion versus Acetate-Free Biofiltration. Blood Purification 2010;30:166-71.
  5. Borrelli S, Minutolo R, De Nicola L, et al., Effect of Hemodiafiltration with Endogenous Reinfusion on Overt Idiopathic Chronic Inflammation in Maintenance Haemodialysis Patients: A Multicentre Longitudinal Study. Hemodial Int. 2014 May 28. doi: 10.1111/hdi.12178.