TY - JOUR
T1 - Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes
AU - Grooteman, Muriel P. C.
AU - van den Dorpel, Marinus A.
AU - Bots, Michiel L.
AU - Penne, E. Lars
AU - van der Weerd, Neelke C.
AU - Mazairac, Albert H. A.
AU - den Hoedt, Claire H.
AU - van der Tweel, Ingeborg
AU - Lévesque, Renée
AU - Nubé, Menso J.
AU - ter Wee, Piet M.
AU - Blankestijn, Peter J.
AU - AUTHOR GROUP
AU - Blankestijn, P. J.
AU - Grooteman, M. P. C.
AU - Nubé, M. J.
AU - terWee, P. M.
AU - Bots, M. L.
AU - van den Dorpel, M. A.
AU - Penne, E. L.
AU - Mazairac, A. H. A.
AU - den Hoedt, C. H.
AU - Arnold, A. E. R.
AU - Bronsveld, W.
AU - Stam, F.
AU - Boer, W. H.
AU - Doevendans, P. A.
AU - Kappelle, L. J.
AU - Visseren, F. L. J.
AU - Kooter, A. J.
AU - Smulders, Y. M.
AU - Visser, M. C.
AU - Veen, G.
AU - Ligtenberg, G.
AU - van der Tweel, I.
AU - Rabelink, T. J.
AU - Stehouwer, C. D. A.
AU - Dorval, M.
AU - Lévesque, R.
AU - Koopman, M. G.
AU - Konings, C. J. A. M.
AU - Haanstra, W. P.
AU - Kooistra, M.
AU - van Jaarsveld, B.
AU - Noordzij, T.
AU - Feith, G. W.
AU - Peltenburg, H. G.
AU - van Buren, M.
AU - Offerman, J. J. G.
AU - Bosch, Jeroen
AU - deHeer, F.
PY - 2012
Y1 - 2012
N2 - 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 high-volume 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
AB - 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 high-volume 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
U2 - https://doi.org/10.1681/ASN.2011121140
DO - https://doi.org/10.1681/ASN.2011121140
M3 - Article
C2 - 22539829
SN - 1046-6673
VL - 23
SP - 1087
EP - 1096
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 6
ER -