Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure

Blankestijn, Peter J.; Vernooij, Robin W.M.; Hockham, Carinna; Strippoli, Giovanni F.M.; Canaud, Bernard; Hegbrant, Jörgen; Barth, Claudia; Covic, Adrian; Cromm, Krister; Cucui, Andrea; Davenport, Andrew; Rose, Matthias; Török, Marietta; Woodward, Mark; Bots, Michiel L.

doi:10.1056/nejmoa2304820

Cited by 64 publications

(17 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After preliminary screening, 38 articles were subjected to a detailed analysis with fulltext reading. Finally, five RCTs [10][11][12]16,17 were included in this study (Figure 1), involving 3505 patients. The 33 excluded articles included reviews, case reports, observational studies, low flux-HD as the comparator group, and study protocols.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…[6][7][8][9] Recently, the CONVINCE group published a study showing a reduction in all-cause mortality with HDF use compared with hf-HD. 10 Nonetheless, previous randomized clinical trials (RCT) did not reveal the same benefit. 11,12 Thus, the present study aimed to pool data from RCTs through a meta-analysis that compared hf-HD and HDF in the mortality of patients with ESRD and maintenance dialysis.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Is hemodiafiltration superior to high‐flow hemodialysis in reducing all‐cause and cardiovascular mortality in kidney failure patients? A meta‐analysis of randomized controlled trials

Bignardi,

Delfino

2024

Hemodialysis International

View full text Add to dashboard Cite

IntroductionHemodiafiltration (HDF) and high‐flux hemodialysis (hf‐HD) are different methods of kidney replacement therapy (KRT) used for the treatment of kidney failure patients. A debate has raged over the last decade about the survival benefit of patients with the use of HDF compared with hf‐HD, but with divergent results from randomized controlled trials. Therefore, this study aimed to perform a meta‐analysis to compare HDF and hf‐HD regarding all‐cause and cardiovascular mortality.MethodsPubMed and Cochrane databases were searched until July 19, 2023, for randomized clinical trials comparing HDF and hf‐HD in patients on maintenance dialysis. A meta‐analysis was performed using Stata 16.1, applying fixed or random effect models according to the heterogeneity between studies.FindingsOf the 496 studies found, five met the inclusion criteria. Compared with the hf‐HD group, the risk ratio (RR) for all‐cause mortality with HDF use was 0.76 (95% CI: 0.67–0.88, I2 = 0%). HDF was associated with lower cardiovascular mortality, although the sensitivity analysis showed that the result differed between scenarios. Subgroup analysis showed lower all‐cause mortality among patients without diabetes in the HDF group compared with hf‐HD (RR 0.66, 95% CI: 0.51–0.81, I2 = 0%), but not in diabetic patients (RR = 0.89, 95% CI: 0.65–1.12, I2 = 0.0%). A subgroup analysis considering convection volumes was not performed, but the studies with the highest weight in the meta‐analysis described convection volume as more than 20 L/session.DiscussionMore clinical studies considering critical risk factors, such as advanced age and preexisting cardiovascular disease, are needed to confirm the supremacy of HDF over hf‐HD on the survival of patients treated by these two forms of kidney replacement therapy.

show abstract

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Is hemodiafiltration superior to high‐flow hemodialysis in reducing all‐cause and cardiovascular mortality in kidney failure patients? A meta‐analysis of randomized controlled trials

Bignardi,

Delfino

2024

Hemodialysis International

View full text Add to dashboard Cite

show abstract

“…Mortality in patients with kidney failure was 23% lower among those treated with high dose haemodiafiltration than in those treated with high flux haemodialysis, found a cross European study published in the New England Journal of Medicine 5. Researchers at the Convince consortium, led by University Medical Center Utrecht, is the first international randomised trial to compare these two treatments.…”

Section: Kidney Failurementioning

confidence: 99%

Seven days in medicine: 14-20 June 2023

2023

BMJ

View full text Add to dashboard Cite

“…11,15 Recently, hemofiltration (HF) showed reduced mortality in dialysis patients compared with hemodialysis. 16 In the current study, we compare the inclusion of a hemofiltrator during NMP of slaughterhouse porcine hearts to standard NMP after 4 hours of static cold storage. We hypothesize that HF results in a more physiologic perfusate composition and superior preservation of myocardial function over time.…”

mentioning

confidence: 99%

Hemofiltration Improves Blood Perfusate Conditions Leading to Improved Ex Situ Heart Perfusion

Kaffka genaamd Dengler,

Mishra,

Vervoorn

et al. 2023

ASAIO Journal

View full text Add to dashboard Cite

The aim was to optimize the perfusate composition by including a hemofiltrator to the PhysioHeartplatform for ex situ heart perfusion of porcine slaughterhouse hearts. Fourteen hearts were harvested from Dutch Landrace pigs and slaughtered for human consumption. All hearts were preserved for 4 hours using static cold storage before reperfusion for 4 hours on the PhysioHeart platform. Seven hearts were assigned to the hemofiltration group, where a hemofiltrator was added to the perfusion circuit, while the control group did not receive hemofiltration. In the hemofiltration group, the perfusion fluid was filtrated for 1 hour with a flow of 1 L/hour before reperfusion. After mounting the heart, hemofiltration was maintained at 1 L/hour, and cardiac function and blood samples were analyzed at multiple time points. Preserved cardiac function was defined as a cardiac output >3.0 L/min with a mean aortic pressure >60 mm Hg and a left atrial pressure <15 mm Hg. Hemofiltration resulted in a significantly reduced potassium concentration at all time points (p < 0.001), while sodium levels remained at baseline values (p < 0.004). Furthermore, creatinine and ammonia levels decreased over time. Functional assessment demonstrated a reduced left atrial pressure (p < 0.04) and a reduction of the required dobutamine dose to support myocardial function (p < 0.003) in the hemofiltration group. Preserved cardiac function did not differ between groups. Hemofiltration results in an improved biochemical composition of the whole blood perfusate and preserves cardiac function better during normothermic perfusion based on a reduced left atrial pressure (LAP) and dobutamine requirement to support function.

show abstract

Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure

Cited by 64 publications

References 26 publications

Is hemodiafiltration superior to high‐flow hemodialysis in reducing all‐cause and cardiovascular mortality in kidney failure patients? A meta‐analysis of randomized controlled trials

Is hemodiafiltration superior to high‐flow hemodialysis in reducing all‐cause and cardiovascular mortality in kidney failure patients? A meta‐analysis of randomized controlled trials

Seven days in medicine: 14-20 June 2023

Hemofiltration Improves Blood Perfusate Conditions Leading to Improved Ex Situ Heart Perfusion

Contact Info

Product

Resources

About