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Titolo High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients
Autore Francisco Maduell, Francesc Moreso, Mercedes Pons, Rosa Ramos, Josep Mora-Macià, Jordi Carreras, Jordi Soler, Ferran Torres, Josep M. Campistol, and Alberto Martinez-Castelao, for the ESHOL Study Group Nephrology Department, Hospital Clinic, Barcelona, Spain; Nephrology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain; ‡CETIRSA, Barcelona, Spain; §Hospital San Antonio Abad, Vilanova i la Geltru, Spain; Fresenius Medical Care, Granollers, Spain; Diaverum Baix Llobregat, Hospitalet, Llobregat, Spain; Fresenius Medical Care, Reus, Spain; Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain; and Nephrology Department, Hospital Universitari Bellvitge, L’Hospitalet, Bellvitge, Spain
Referenza J Am Soc Nephrol 2013; doi: 10.1681/ASN.2012080875

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.

Data 15.02.2013
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