Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes
Muriel P C Grooteman, Marinus A van den Dorpel, Michiel L Bots, E Lars Penne, Neelke C van der Weerd, Albert H A Mazairac, Claire H den Hoedt, Ingeborg van der Tweel, Renée Lévesque, Menso J Nubé, Piet M ter Wee, Peter J Blankestijn, CONTRAST Investigators, P J Blankestijn, M P C Grooteman, M J Nubé, P M terWee, M L Bots, M A van den Dorpel, E L Penne, N C van der Weerd, A H A Mazairac, C H den Hoedt, A E R Arnold, W Bronsveld, F Stam, W H Boer, P A Doevendans, L J Kappelle, F L J Visseren, A J Kooter, Y M Smulders, M C Visser, G Veen, G Ligtenberg, I van der Tweel, T J Rabelink, C D A Stehouwer, 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, Jeroen Bosch, F deHeer, 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, Muriel P C Grooteman, Marinus A van den Dorpel, Michiel L Bots, E Lars Penne, Neelke C van der Weerd, Albert H A Mazairac, Claire H den Hoedt, Ingeborg van der Tweel, Renée Lévesque, Menso J Nubé, Piet M ter Wee, Peter J Blankestijn, CONTRAST Investigators, P J Blankestijn, M P C Grooteman, M J Nubé, P M terWee, M L Bots, M A van den Dorpel, E L Penne, N C van der Weerd, A H A Mazairac, C H den Hoedt, A E R Arnold, W Bronsveld, F Stam, W H Boer, P A Doevendans, L J Kappelle, F L J Visseren, A J Kooter, Y M Smulders, M C Visser, G Veen, G Ligtenberg, I van der Tweel, T J Rabelink, C D A Stehouwer, 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, Jeroen Bosch, F deHeer, 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
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.
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Source: PubMed