The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy

Claire H den Hoedt, Muriel P C Grooteman, Michiel L Bots, Peter J Blankestijn, Ingeborg van der Tweel, Neelke C van der Weerd, E Lars Penne, Albert H A Mazairac, Renée Levesque, Piet M ter Wee, Menso J Nubé, Marinus A van den Dorpel, CONTRAST investigators, M Dorval, R Lévesque, M G Koopman, C J A M Konings, W P Haanstra, M Kooistra, B van Jaarsveld, T Noordzij, G W Feith, H G Peltenburg, M van Buren, J J G Offerman, E K Hoogeveen, F de Heer, P J van de Ven, T K Kremer Hovinga, W A Bax, J O Groeneveld, A T J Lavrijssen, A M Schrander-Van der Meer, L J M Reichert, J Huussen, P L Rensma, Y Schrama, H W van Hamersvelt, W H Boer, W H van Kuijk, M G Vervloet, I M P M J Wauters, I Sekse, Claire H den Hoedt, Muriel P C Grooteman, Michiel L Bots, Peter J Blankestijn, Ingeborg van der Tweel, Neelke C van der Weerd, E Lars Penne, Albert H A Mazairac, Renée Levesque, Piet M ter Wee, Menso J Nubé, Marinus A van den Dorpel, CONTRAST investigators, M Dorval, R Lévesque, M G Koopman, C J A M Konings, W P Haanstra, M Kooistra, B van Jaarsveld, T Noordzij, G W Feith, H G Peltenburg, M van Buren, J J G Offerman, E K Hoogeveen, F de Heer, P J van de Ven, T K Kremer Hovinga, W A Bax, J O Groeneveld, A T J Lavrijssen, A M Schrander-Van der Meer, L J M Reichert, J Huussen, P L Rensma, Y Schrama, H W van Hamersvelt, W H Boer, W H van Kuijk, M G Vervloet, I M P M J Wauters, I Sekse

Abstract

Background: 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.

Patients and methods: 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.

Results: 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).

Conclusions: HDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings.

Trial registration: ClinicalTrials.gov NCT00205556.

Conflict of interest statement

Competing Interests: We have the following interests: This study was funded in part by Fresenius Medical Care (The Netherlands), Gambro Lundia AB (Sweden) and Roche Netherlands. Muriel PC Grooteman reports to be under negotiation for grant support from Fresenius Medical Care and reports receiving lecture fees from Fresenius Medical Care BV, The Netherlands. Pieter M ter Wee reports consulting support by Amgen and Sanofi and grant support from the Dutch Kidney Foundation. Menso J Nubé reports to be under negotiation for grant support from Fresenius Medical Care. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Enrolment, randomization, and follow-up of…
Fig 1. Enrolment, randomization, and follow-up of study participants.
For infections, all patients were followed until drop out, death or the end of the study.

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