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Titolo Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes
Autore 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, Renee Levesque, Menso J. Nubé, Piet M. ter Wee, Peter J. Blankestij and for the CONTRAST Investigators
Referenza JASN 2012; doi: 10.1681/ASN.2011121140


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, nonfatall 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 highvolume hemodiafiltration during the trial associated with lower all-causemortality, 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.

Data 14.05.2012
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