High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients
Francisco Maduell, Francesc Moreso, Mercedes Pons, Rosa Ramos, Josep Mora-Macià, Jordi Carreras, Jordi Soler, Ferran Torres, Josep M Campistol, Alberto Martinez-Castelao, ESHOL Study Group, M Pons, B Insensé, C Perez, T Feliz, R Ramos, M Barbetta, C Soto, J Mora, A Juan, O Ibrik, A Foraster, J Carreras, F Moreso, J Nin, A Fernández, J Soler, M Arruche, C Sánchez, J Vidiella, F Barbosa, M Chiné, S Hurtado, J Llibre, A Ruiz, M Serra, M Salvó, T Poyuelo, F Maduell, M Carrera, N Fontseré, M Arias, Josep M Campistol, A Merín, L Ribera, J M Galceran, J Mòdol, E Moliner, A Ramirez, J Aguilera, M Alvarez, J Casellas, G Martín, E Andres, E Coll, M Valles, C Martínez, E Castellote, J M Casals, J Gabàs, M Romero, A Martinez-Castelao, X Fulladosa, M Ramirez-Arellano, M Fulquet, A Pelegrí, M el Manouari, N Ramos, J Bartolomé, R Sans, E Fernández, F Sarró, T Compte, F Marco, R Mauri, J Bronsoms, J A Arnaiz, H Beleta, A Pejenaute, F Torres, J Ríos, J Lara, Francisco Maduell, Francesc Moreso, Mercedes Pons, Rosa Ramos, Josep Mora-Macià, Jordi Carreras, Jordi Soler, Ferran Torres, Josep M Campistol, Alberto Martinez-Castelao, ESHOL Study Group, M Pons, B Insensé, C Perez, T Feliz, R Ramos, M Barbetta, C Soto, J Mora, A Juan, O Ibrik, A Foraster, J Carreras, F Moreso, J Nin, A Fernández, J Soler, M Arruche, C Sánchez, J Vidiella, F Barbosa, M Chiné, S Hurtado, J Llibre, A Ruiz, M Serra, M Salvó, T Poyuelo, F Maduell, M Carrera, N Fontseré, M Arias, Josep M Campistol, A Merín, L Ribera, J M Galceran, J Mòdol, E Moliner, A Ramirez, J Aguilera, M Alvarez, J Casellas, G Martín, E Andres, E Coll, M Valles, C Martínez, E Castellote, J M Casals, J Gabàs, M Romero, A Martinez-Castelao, X Fulladosa, M Ramirez-Arellano, M Fulquet, A Pelegrí, M el Manouari, N Ramos, J Bartolomé, R Sans, E Fernández, F Sarró, T Compte, F Marco, R Mauri, J Bronsoms, J A Arnaiz, H Beleta, A Pejenaute, F Torres, J Ríos, J Lara
Abstract
Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.
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Source: PubMed