Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study

Panichi, Vincenzo; Rizza, Giovanni Manca; Paoletti, Sabrina; Bigazzi, Roberto; Aloisi, Marta; Barsotti, Giovanni; Rindi, P; Donati, G; Antonelli, Alessandro; Panicucci, Erica; Tripepi, Gianni; Tetta, Ciro; Palla, Roberto

doi:10.1093/ndt/gfm951

Cited by 199 publications

(158 citation statements)

References 29 publications

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“…[4][5][6][7] Several nonrandomized observational studies suggested a survival benefit in patients who are treated with online hemodiafiltration. [8][9][10][11] However, small randomized studies failed to show a difference between online hemodiafiltration and standard hemodialysis (as summarized by van der Weerd et al 12 ). On the basis of the above-mentioned theoretical considerations, the absence of conclusive clinical data, and the growing interest in convective techniques, the Convective Transport Study (CONTRAST) was initiated (ClinicalTrials.…”

mentioning

confidence: 99%

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Grooteman

Dorpel

Bots

et al. 2012

Journal of the American Society of Nephrology

460

423

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In patients with ESRD, the effects of online hemodiafiltration on all-cause mortality and cardiovascular events are unclear. In this prospective study, we randomly assigned 714 chronic hemodialysis patients to online postdilution hemodiafiltration (n=358) or to continue low-flux hemodialysis (n=356). The primary outcome measure was all-cause mortality. The main secondary endpoint was a composite of major cardiovascular events, including death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, therapeutic coronary intervention, therapeutic carotid intervention, vascular intervention, or amputation. After a mean 3.0 years of follow-up (range, 0.4-6.6 years), we did not detect a significant difference between treatment groups with regard to all-cause mortality (121 versus 127 deaths per 1000 person-years in the online hemodiafiltration and low-flux hemodialysis groups, respectively; hazard ratio, 0.95; 95% confidence interval, 0.75-1.20). The incidences of cardiovascular events were 127 and 116 per 1000 person-years, respectively (hazard ratio, 1.07; 95% confidence interval, 0.83-1.39). Receiving highvolume hemodiafiltration during the trial associated with lower all-cause mortality, a finding that persisted after adjusting for potential confounders and dialysis facility. In conclusion, this trial did not detect a beneficial effect of hemodiafiltration on all-cause mortality and cardiovascular events compared with low-flux hemodialysis. On-treatment analysis suggests the possibility of a survival benefit among patients who receive high-volume hemodiafiltration, although this subgroup finding requires confirmation.

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mentioning

confidence: 99%

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Grooteman

Dorpel

Bots

et al. 2012

Journal of the American Society of Nephrology

460

423

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“…Actually, lower predialysis ␤2M levels have been reported after 3 to 12 mo treatment with HDF, as compared with low-flux or high-flux HD (10)(11)(12)(13)(14)(15). It has been proposed that the improved survival of HDF patients, as reported in few observational studies (16)(17)(18), can be partly attributed to increased removal of ␤2M and other MMW uremic toxins by convective transport.…”

mentioning

confidence: 99%

Role of Residual Kidney Function and Convective Volume on Change in β2-Microglobulin Levels in Hemodiafiltration Patients

Penne

Weerd

Blankestijn

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Removal of ␤ 2 -microglobulin (␤2M) can be increased by adding convective transport to hemodialysis (HD). The aim of this study was to investigate the change in ␤2M levels after 6-mo treatment with hemodiafiltration (HDF) and to evaluate the role of residual kidney function (RKF) and the amount of convective volume with this change.Design, setting, participants, & measurements: Predialysis serum ␤2M levels were evaluated in 230 patients with and 176 patients without RKF from the CONvective TRAnsport STudy (CONTRAST) at baseline and 6 mo after randomization for online HDF or low-flux HD. In HDF patients, potential determinants of change in ␤2M were analyzed using multivariable linear regression models.Results: Mean serum ␤2M levels decreased from 29.5 ؎ 0.8 (؎SEM) at baseline to 24.3 ؎ 0.6 mg/L after 6 mo in HDF patients and increased from 31.9 ؎ 0.9 to 34.4 ؎ 1.0 mg/L in HD patients, with the difference of change between treatment groups being statistically significant (regression coefficient ؊7.7 mg/L, 95% confidence interval ؊9.5 to ؊5.6, P < 0.001). This difference was more pronounced in patients without RKF as compared with patients with RKF. In HDF patients, ␤2M levels remained unchanged in patients with GFR >4.2 ml/min/1.73 m 2 . The ␤2M decrease was not related to convective volume. Conclusions: This study demonstrated effective lowering of ␤2M levels by HDF, especially in patients without RKF. The role of the amount of convective volume on ␤2M decrease appears limited, possibly because of resistance to ␤2M transfer between body compartments.

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“…1. Typically, convective diffusive procedures are characterized by an additional removal of hydrophobic middle molecules and protein (albumin) bound uremic toxins depending on the membrane characteristics (hydrophobic areas, pore size, adsorptive properties, biocompatibility) (Ahrenholz et al, 2004;Panicchi et al, 2008). The loss of protein bound substances leads to a membrane determined l o s s o f a l b u m i n d u ring olHDF sessions (Ahrenholz et al, 2004;Samtleben et al, 2003;Combarnous et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…However, none-biocompatible membranes and partly low flux hemodialysis increases proinflammatory cytokines such as TNF-alpha. Ultrapure dialysis fluid is of relevant importance to prevent inflammation (Panicchi et al, 2008). On the other hand complement activation plays a role for inflammation during the dialysis sessions therefore biocompatible membranes are urgently necessary (Hakim et al, 1984).…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of dialysis measured by single pool Kt/V could be improved (Ahrenholz et al, 1997;Ding et al, 2002). There is evidence of longer survival of patients treated by olHDF versus hemodialysis (HD) independently of dialysis dosage (Canaud et al, 2008;Panicchi et al, 2008). The cycling of hemoglobin levels depends on inflammatory episodes and malnutrition (Del et al, 2005;Brimble et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of Online Hemodiafiltration on Hemoglobin Level, ESA-Dosage and Serum Albumin – A Retrospective, Multicenter Analysis

Winkler¹,

Ahrenholz²,

Freivogel³

2011

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice

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Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study

Abstract: Data at 30 months from this study showed the synergic effect of CRP and pro-inflammatory cytokines as the strong predictors of all-cause and CV mortality. HDF was associated with an improved cumulative survival independent of the dialysis dose.

Cited by 199 publications

References 29 publications

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Role of Residual Kidney Function and Convective Volume on Change in β2-Microglobulin Levels in Hemodiafiltration Patients

Influence of Online Hemodiafiltration on Hemoglobin Level, ESA-Dosage and Serum Albumin – A Retrospective, Multicenter Analysis

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