Introduction: Patients often suffer from symptoms during dialysis. Haemodiafiltration (HDF) therapy has been suggested to be superior to standard haemodialysis (HD). To understand patients' experiences, we quantified the burden and duration of dialysis-associated symptoms to determine whether there was any difference between the modalities. Methods: Symptom questionnaires (83.3%) were returned by 623 dialysis outpatients. Symptom scores were analysed using a visual analogue score. We compared symptom burdens during HD and HDF treatments and also whether the scores changed following a modality change to HDF. Results: Among the patients, 55.7% were men, the median age was 65 years, 39.7% were diabetic, 26.4% were treated by HDF and the median unadjusted Charlson co-morbidity score was 6 (IQR 4-8). Fatigue (77.3%), intra-dialytic hypotension (76.4%), cramps (74.3%) and dizziness (63%) were the commonest symptoms reported, followed by headache (53.6%) and pruritus (52.2%). Although most symptoms were reported less frequently with HDF [median headache frequency score: HD: 1 (IQR 1-4) vs. HDF: 0 (IQR 0-2), p < 0.005]. There was no evidence of a reduction in symptom scores in patients switching from HD to HDF compared to those remaining on HD. Conclusion: Patient self-reporting shows that most patients frequently suffer symptoms. There was no evidence that switching to HDF improved symptoms in patients established on HD.

Carson RC, Juszczak M, Davenport A, Burns A: Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol 2009;4:1611-1619.
Claxton RN, Blackhall L, Weisbord SD, Holley JL: Undertreatment of symptoms in patients on maintenance haemodialysis. J Pain Symptom Manage 2010;9:211-218.
Brunet P, Saingra Y, Leonetti F, Vader-Coponat H, Ramnamamarivo P, Berland Y: Tolerance of haemodialysis: a randomized cross-over trial of 5-h versus 4-h treatment time. Nephrol Dial Transplant 1996;11(suppl 8):46-51.
Murtagh FE, Addington-Hall JM, Edmonds PM, Donohoe P, Carey I, Jenkins K, Higginson IJ: Symptoms in advanced renal disease: a cross-sectional survey of symptom prevalence in stage 5 chronic kidney disease managed without dialysis. J Palliat Med 2007;10:1266-1276.
Murtagh FE, Addington-Hall J, Higginson IJ: The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis 2007;14:82-99.
Tsuchida K, Minakuchi J: Effect of large-size dialysis membrane and haemofiltration/haemodiafiltration methods on long-term dialysis patients. Contrib Nephrol 2011;168:179-187.
Davenport A: Can advances in haemodialysis machine technology prevent intradialytic hypotension? Semin Dial 2009;22:231-236.
Oates T, Pinney JH, Davenport A: Haemodiafiltration versus high-flux haemodialysis: effects on phosphate control and erythropoietin response. Am J Nephrol 2011;33:70-75.
Davenport A, Gardner C, Delaney M, Pan Thames Renal Audit Group: The effect of dialysis modality on phosphate control: haemodialysis compared to haemodiafiltration - the Pan Thames Renal Audit. Nephrol Dial Transplant 2010;25:897-901.
Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, Basile C, David S, Feriani M, Montagna G, Di Iorio BR, Memoli B, Cravero R, Battaglia G, Zoccali C: Haemofiltration and haemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 2010;21:1798-1807.
Caplin B, Kumar S, Davenport A: Patients' perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant 2011;26:2656-2663.
Griva K, Ziegelmann JP, Thompson D, Jayasena D, Davenport A, Harrison M, Newman SP: Quality of life and emotional responses in cadaver and living related renal transplant recipients. Nephrol Dial Transplant 2002;17:2204-2211.
Griva K, Newman SP, Harrison MJ, Hankins M, Davenport A, Hansraj S, Thompson D: Acute neuropsychological changes in haemodialysis and peritoneal dialysis patients. Health Psychol 2003;22:570-578.
Griva K, Hansraj S, Thompson D: Neuropsychological performance after kidney transplantation: a comparison between transplant types and in relation to dialysis and normative data. Nephrol Dial Transplant 2004;19:1866-1874.
Griva K, Thompson D, Jayasena D, Davenport A, Harrison M, Newman SP: Cognitive functioning pre- to post-kidney transplantation - a prospective study. Nephrol Dial Transplant 2006;21:3275-3282.
Griva K, Jayasena D, Davenport A, Harrison M, Newman SP: Illness and treatment cognitions and health related quality of life in end stage renal disease. Br J Health Psychol 2009;14:17-34.
Davenport A: Intradialytic complications during haemodialysis. Hemodial Int 2006;10:162-167.
Vernon K, Peasegood J, Riddell A, Davenport A: Dialyzers designed to increase internal filtration do not result in significantly increased platelet activation and thrombin generation. Nephron Clin Pract 2011;117:c403-c408.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
Davies SJ, Phillips L, Naish PF, Russell GI: Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival. Nephrol Dial Transplant 2002;17:1085-1092.
Davenport A: Low-molecular-weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments. Nephrology (Carlton) 2009;14:455-461.
Pinney JH, Oates T, Davenport A: Haemodiafiltration does not reduce the frequency of intradialytic hypotensive episodes when compared to cooled high-flux haemodialysis. Nephron Clin Pract 2011;119:c138-c144.
Beerenhout CH, Kooman JP, Luik AJ, Jeuken-Mertens SG, Van Der Sande FM, Leunissen KM: Optimizing renal replacement therapy - a case for online filtration therapies? Nephrol Dial Transplant 2002;17:2065-2070.
Davenport A, Gura V, Ronco C, Beizai M, Ezon C, Rambod E: A wearable haemodialysis device for patients with end-stage renal failure: a pilot study. Lancet 2007;370:2005-2010.
Jaber BL, Lee Y, Collins AJ, Hull AR, Kraus MA, McCarthy J, Miller BW, Spry L, Finkelstein FO, FREEDOM Study Group: Effect of daily haemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis 2010;56:531-539.
Maduell F, Navarro V, Torregrosa E, Rius A, Dicenta F, Cruz MC, Ferrero JA: Change from three times a week on-line haemodiafiltration to short daily on-line haemodiafiltration. Kidney Int 2003;64:305-313.
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