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Background: Intradialytic hypotension (IDH) and subsequent tissue damage may contribute to the poor outcome of chronic haemodialysis (HD) patients. While the IDH-incidence is lower in high-volume haemodiafiltration (HV-HDF) than in standard HD (S-HD), survival is better in HV-HDF. Tissue injury, as measured by extracellular vesicle (EV)-release, was compared between four modalities., Methods: Forty chronic patients were cross-over randomized to S-HD, cool-HD (C-HD), low-volume HDF (LV-HDF), and HV-HDF. Blood pressure was recorded every 15 minutes. EVs from circulating blood-cell-elements (bio-incompatibility-related) and cardiovascular (CV) tissues (CV-related), were measured before and after dialysis. The influence of modalities and IDH on the rate of change of EVs was assessed. Both crude and haemoconcentration-adjusted analyses were performed., Results: Leukocyte and erythrocyte-derived EVs increased in all modalities. Platelet-derived EVs increased more in LV-HDF and HV-HDF (68.4 respectively 56.1 × 10 6 /ml) than in S-HD (27.5 × 10 6 /ml), P values for interaction were <.01 respectively .06. Endothelial-derived CD144 + (2.3 × 10 6 /ml in HV-HDF and 9.8 × 10 6 /ml in S-HD) and cardiomyocyte-derived Connexin-43 + (12.0 respectively 31.9 × 10 6 /ml) EVs increased less in HV-HDF than in S-HD ( P for interaction .03 respectively .06). Correction for haemoconcentration attenuated all changes, although the increase in platelet-derived EVs remained significant in LV-HDF and HV-HDF, and CD144 + and Connexin-43 + EVs increased most in S-HD. EV release was similar in patients with varying IDH susceptibility and in sessions with and without IDH., Conclusions: Most EVs increase during HD and HDF. Regarding platelet-derived EVs, HDF appears less biocompatible than HD. Considering CV-related EVs, tissue injury seems less pronounced in HV-HDF. The finding that EV release is IDH-independent needs confirmation., Competing Interests: M.J.N., M.P.C.G., and P.A.R. report unrestricted grant support, paid to the institution, from Niercentrum aan de Amstel, Elyse Klinieken, the Netherlands, and B. Braun Avitum AG, Melsungen, Germany. All other authors declared no competing interests. B. Braun Avitum AG and Niercentrum aan de Amstel had no involvement in the collection, analysis and interpretation of data, or in the reporting of the results. Members of the study team are not employed by B. Braun Avitum AG or Niercentrum aan de Amstel., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Aim: Standard haemodialysis (sHD) is associated with a poor survival and marked adverse intradialytic patient-reported outcome measures (ID-PROMs). Whereas physical ID-PROMs (PID-PROMs) are alleviated by cool dialysate (cHD), survival is prolonged by haemodiafiltration (HDF). So far, PID-PROMs are not prospectively compared between HD and HDF., Methods: To assess whether PID-PROMs and thermal perception differ between sHD, cHD, low volume HDF (lvHDF) and high volume HDF (hvHDF), 40 patients were cross-over randomized to each modality for 2 weeks. Dialysate temperature (T d ) was 36.5°C, except in cHD (T d 35.5°C). Target convection volumes were 15 L in lvHDF and ≥ 23 L in hvHDF. PID-PROMs were evaluated with a modified Dialysis Symptom Index (mDSI) and thermal perception with the Visual Analogue Scale Thermal Perception (VAS-TP). T b and room temperature were measured as well., Results: Except for the item 'feeling cold' during cHD (p = .01), PID-PROMs did not differ between modalities, but varied markedly between patients (11/13 items, p < .05). T b increased in sHD, lvHDF, and hvHDF (+0.30, 0.35, 0.38°C, respectively, all p < .0005), but remained stable in cHD (+0.04°C, p = .43). Thermal perception remained unaltered in sHD and both HDF modalities, but shifted towards cold in cHD (p = .007)., Conclusion: (1) PID-PROMs did not differ between modalities, but varied markedly between patients. Hence, PID-PROMs are largely patient-dependent. (2) While T b increased in sHD, lvHDF and hvHDF, thermal perception did not change. Yet, whereas T b remained unaltered in cHD, cold perception emerged. Hence, as for bothersome cold sensations, cHD should be avoided in perceptive individuals., (© 2023 The Authors. Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.)