Mortality risk for patients receiving hemodiafiltration versus hemodialysis

Jirka, Tomáš; Cesare, S.; Benedetto, Attilio Di; Chang, Min-Yu; Ponce, Pedro; Richards, Nick; Tetta, Ciro; Vaslaky, L.

doi:10.1038/sj.ki.5001759

Cited by 85 publications

(69 citation statements)

References 3 publications

(3 reference statements)

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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.…”

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confidence: 92%

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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confidence: 92%

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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“…[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.…”

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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

449

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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“…HDF outcome data range from moderate-sized safety and efficacy studies (4,9 -11) to large registry studies (12,13). Recent data from the Cardiovascular Risk in Dialysis (RISCAVID) study suggest a survival benefit for both online HDF and sterile bag HDF over standard low-flux HD (14); however, data comparing outcomes between high-flux HD and HDF are limited to a very small (n ϭ 76), single-center, randomized, crossover study (15), which demonstrated improved ␤2 microglobulin clearance with online HDF, but the study design did not allow conclusions to be drawn about mortality.…”

mentioning

confidence: 99%

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

Vilar

Fry

Wellsted

et al. 2009

Clinical Journal of the American Society of Nephrology

144

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Mortality risk for patients receiving hemodiafiltration versus hemodialysis

Abstract: 4. Xu D, Kyriakis JM. Phosphatidylinositol 3 0 -kinase-dependent activation of renal mesangial cell Ki-Ras and ERK by advanced glycation end products.

Cited by 85 publications

References 3 publications

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

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

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

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

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