Long-Term Outcomes in Online Hemodiafiltration and High-Flux Hemodialysis

Vilar, E.; Fry, AC; Wellsted, David; Tattersall, James; Greenwood, Roger; Farrington, Ken

doi:10.2215/cjn.05560809

Cited by 147 publications

(124 citation statements)

References 37 publications

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“…There is increasing interest in techniques that maximize middle-molecule clearance, such as hemodiafiltration (HDF) (14,15). Clearance of these molecules may be an important marker of adequate treatment in both peritoneal dialysis (10,16) and hemodialysis (HD) (11,17).…”

Section: Introductionmentioning

confidence: 99%

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Vilar

Boltiador

Viljoen

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Cystatin C is a 13.3 kD middle molecule of similar size to b 2 -microglobulin and a marker of GFR in CKD. This study aimed to determine cystatin C kinetics in hemodialysis to understand whether blood concentrations may predict residual renal function and middle-molecule clearance.Design, setting, participants, & measurements Cystatin C removal and rebound kinetics were studied in 24 patients on high-flux hemodialysis or hemodiafiltration. To determine whether cystatin C concentrations are predictable, an iterative two-pool mathematical model was applied.Results Cystatin C was cleared effectively, although less than b 2 -microglobulin (reduction ratios6SD are 39%611 and 51%611). Cystatin C rebounded to 95%65% of predialysis concentration by 12 hours postdialysis. The two-pool kinetic model showed excellent goodness of fit. Modeled extracellular cystatin C pool volume is smaller than that predicted, comprising 25.5%69.2 of total body water. Iterated parameters, including nonrenal clearance, showed wide interindividual variation. Modeled nonrenal clearance was substantially higher than renal clearance in this population at 25.166.6 ml/min per 1.73 m 2 body surface area.Conclusions Plasma cystatin C levels may be used to measure middle-molecule clearance. Levels rebound substantially postdialysis and plateau in the interdialytic period. At low GFR, nonrenal clearance predominates over renal clearance, and its interindividual variation will limit use of cystatin C to predict residual renal function in advanced kidney disease.

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Section: Introductionmentioning

confidence: 99%

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Vilar

Boltiador

Viljoen

et al. 2014

Clinical Journal of the American Society of Nephrology

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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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“…E. Vilar с соавт. (626 пациентов на ВПГД, 232 -на ГДФ) сообщают, что по резуль-татам мультивариантного анализа, преимуществен-ное лечение ГДФ (>50% проведенных процедур) являлось статистически значимым независимым предиктором снижения риска смерти, по сравне-нию с преимущественным лечением ВПГД [16]. В исследовании J. Vinhas с соавт.…”

Section: влияние на смертностьunclassified

“…Vilar с соавт. также отмечают, что эпизоды ИДГ были более частыми у пациентов при лечении ВПГД, чем при лечении ОЛ-ГДФ (0,05/ процедуру против 0,03/процедуру, p < 0,001) [16]. Особый интерес представляют данные ретроспек-тивного исследования, проведенного F.G. MoraBravo с соавт.…”

Section: улучшение гемодинамической стабильностиunclassified

Online Hemodiafiltration: Clinical Results and Economic Evaluation

Поз¹,

Строков²,

Копылова³

2014

Russian Journal of Transplantology and Artificial Organs

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Безопасность ОЛ-ГДФ целиком основывает-ся на строгом и постоянном соблюдении правил проведения процедуры и обслуживания оборудо-вания. В настоящее время около 15% диализных пациентов Западной Европы получают ОЛ-ГДФ, в России эту методику практикует треть центров ге-модиализа (ГД). Ограничивающим фактором для более широкого применения этого метода явля-ются законодательно-административные барьеры на использование приготавливаемой онлайн заме-щающей жидкости [1]. Главный принцип онлайн-приготовления замещающего раствора -постоян-ная стерилизация с помощью ультрафильтрации (УФ) и непосредственное использование -не рассматривается Фармакопеей в качестве стери-лизационного метода. Изготовление лекарства (замещающий раствор) с помощью аппарата (из диализирующей жидкости) с использованием дру-гого устройства (ультрафильтр) -процесс, выхо- Вторая часть обзора посвящена правовым и финансовым аспектам онлайн-гемодиафильтрации, а также ее влиянию на непосредственные и отдаленные результаты лечения. Недавно завершенные рандомизи-рованные исследования подтвердили, что высокообъемная онлайн-гемодиафильтрация позволяет улуч-шить выживаемость пациентов. Эти данные должны переломить инерцию, препятствующую повсемес-тному внедрению онлайн-гемодиафильтрации в качестве основной методики в практику программного гемодиализа.Ключевые слова: онлайн-гемодиафильтрация, регулирование, клиническая эффективность. Second part of review summarizes legal and fi nancial aspects of online hemodiafi ltration and its infl uence on short-term and long-term treatment results. According to recently completed randomized clinical trials, high volume online hemodiafi ltration is able to improve patients' survival rate. The results mentioned in the review must overpower the inertia which obstructs a wide implementation of online hemodiafi ltration into routine clinical practice. ONLINE HEMODIAFILTRATION: CLINICAL RESULTS AND ECONOMIC EVALUATION

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Long-Term Outcomes in Online Hemodiafiltration and High-Flux Hemodialysis

Abstract: Conclusions: We found no benefits of HDF over high-flux HD with respect to anemia management, nutrition, mineral metabolism, and BP control. The mortality benefit associated with HDF requires confirmation in large randomized, controlled trials. These data may contribute to their design.

Cited by 147 publications

References 37 publications

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

Removal and Rebound Kinetics of Cystatin C in High-Flux Hemodialysis and Hemodiafiltration

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

Online Hemodiafiltration: Clinical Results and Economic Evaluation

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