TY - JOUR
T1 - The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy
AU - den Hoedt, Claire H.
AU - Grooteman, Muriel P. C.
AU - Bots, Michiel L.
AU - Blankestijn, Peter J.
AU - van der Tweel, Ingeborg
AU - van der Weerd, Neelke C.
AU - Penne, E. Lars
AU - Mazairac, Albert H. A.
AU - Levesque, Renée
AU - ter Wee, Piet M.
AU - Nubé, Menso J.
AU - van den Dorpel, Marinus A.
AU - AUTHOR GROUP
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 - Hoogeveen, E. K.
AU - de Heer, F.
AU - van de Ven, P. J.
AU - Hovinga, T. K. Kremer
AU - Bax, W. A.
AU - Groeneveld, J. O.
AU - Lavrijssen, A. T. J.
AU - Schrander-van der Meer, A. M.
AU - Reichert, L. J. M.
AU - Huussen, J.
AU - Rensma, P. L.
AU - Schrama, Y.
AU - van Hamersvelt, H. W.
AU - Boer, W. H.
AU - van Kuijk, W. H.
AU - Vervloet, M. G.
AU - Wauters, I. M. P. M. J.
AU - Sekse, I.
PY - 2015
Y1 - 2015
N2 - Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections. We used data of the 714 HD patients (age 64 ±14, 62% men, 25% Diabetes Mellitus, 7% catheters) participating in the CONvective TRAnsport STudy (CONTRAST), a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD. The events were adjudicated by an independent event committee. The risk of infectious events was compared with Cox regression for repeated events and Cox proportional hazard models. The distributions of types of infection were compared between the groups. Thirty one percent of the patients suffered from one or more infections leading to hospitalization during the study (median follow-up 1.96 years). The risk for infections during the entire follow-up did not differ significantly between treatment arms (HDF 198 and HD 169 infections in 800 and 798 person-years respectively, hazard ratio HDF vs. HD 1.09 (0.88-1.34), P = 0.42. No difference was found in the occurrence of the first infectious event (either fatal, non-fatal or type specific). Of all infections, respiratory infections (25% in HDF, 28% in HD) were most common, followed by skin/musculoskeletal infections (21% in HDF, 13% in HD). HDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings. ClinicalTrials.gov NCT00205556
AB - Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections. We used data of the 714 HD patients (age 64 ±14, 62% men, 25% Diabetes Mellitus, 7% catheters) participating in the CONvective TRAnsport STudy (CONTRAST), a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD. The events were adjudicated by an independent event committee. The risk of infectious events was compared with Cox regression for repeated events and Cox proportional hazard models. The distributions of types of infection were compared between the groups. Thirty one percent of the patients suffered from one or more infections leading to hospitalization during the study (median follow-up 1.96 years). The risk for infections during the entire follow-up did not differ significantly between treatment arms (HDF 198 and HD 169 infections in 800 and 798 person-years respectively, hazard ratio HDF vs. HD 1.09 (0.88-1.34), P = 0.42. No difference was found in the occurrence of the first infectious event (either fatal, non-fatal or type specific). Of all infections, respiratory infections (25% in HDF, 28% in HD) were most common, followed by skin/musculoskeletal infections (21% in HDF, 13% in HD). HDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings. ClinicalTrials.gov NCT00205556
U2 - https://doi.org/10.1371/journal.pone.0135908
DO - https://doi.org/10.1371/journal.pone.0135908
M3 - Article
C2 - 26288091
SN - 1932-6203
VL - 10
SP - e0135908
JO - PLOS ONE
JF - PLOS ONE
IS - 8
M1 - e0135908
ER -