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Titolo [LBCT3] ONLINE HEMODIAFILTRATION VERSUS LOW-FLUX HEMODIALYSIS: EFFECTS ON ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN A RANDOMIZED CONTROLLED TRIAL. THE CONVECTIVE TRANSPORT STUDY (CONTRAST)
Autore Muriel Grooteman,1 René van den Dorpel,2 Michiel Bots,3 Lars Penne,1,4 Neelke van der Weerd,1 Albert Mazairac,4 Claire den Hoedt,2 Ingeborg van der Tweel,3 Renée Lévesque,5 Menso Nubé,1 Pieter ter Wee,1 Peter Blankestijn4. 1Nephrology, Vrije Universiteit VU Medical Center, Amsterdam, Netherlands; 2Internal Medicine, Maasstad Hospital, Rotterdam, Netherlands; 3Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands; 4Nephrology, University Medical Center Utrecht, Utrecht, Netherlands; 5Nephrology, Centre Hospitalier de l\'Université de Montréal, Montreal, QC, Canada
Referenza ERA-EDTA CONGRESS - PRAGA 2011 - LBCT3
Contenuto INTRODUCTION AND AIMS: In patients with end stage renal disease, the effects of online hemodiafiltration (online HDF) on all cause mortality and cardiovascular events are unclear. We addressed the hypothesis that treatment with online hemodiafiltration would result in a reduction in the risk of all cause mortality. METHODS: We randomly assigned 714 prevalent hemodialysis patients to undergo either online HDF (post-dilution, target convection volume 6 L/h; N=358) or lowflux hemodialysis (HD, N=356). The primary outcome was all cause mortality. The main secondary endpoint was the composite of fatal and non fatal major cardiovascular events (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, and coronary, carotid or peripheral vascular intervention). Various prespecified subgroups of patients were analyzed as well. RESULTS: The convection volume achieved in the online HDF group was 19.1 ± 3 L/session. After a mean follow-up of 3.03 years (range 0.4 - 6.6 years), the incidence of all cause mortality was not affected by treatment assignment (121/1000 person-years with online HDF versus 128/1000 person-years with low flux HD; hazard ratio 0.91; 95% confidence interval [CI], 0.70 to 1.17). The incidence of fatal and non fatal cardiovascular events was 127/1000 person-years versus 111/1000 person-years (hazard ratio 1.12; 95% CI, 0.86 to 1.46). Explorative analyses of predefined subgroups, based on residual kidney function and dialysis vintage, did not yield marked differences between online HDF and low flux HD. A graded benefit on all cause mortality was observed in patients treated with HDF who achieved high average convection volumes during the course of the study: over 20 liter/treatment was associated with a reduction of mortality risk (hazard ratio 0.66; 95% confidence interval 0.45-0.96, p=0.03). CONCLUSIONS: In prevalent hemodialysis patients with end stage renal disease, treatment with online post-dilution hemodiafiltration does not seem to offer a survival benefit as compared to low flux hemodialysis within a three year timeframe. However, subgroup analysis suggested benefit among patients treated with high convection volumes on all cause mortality. (Clinicaltrials.gov number NCT 00205556) DISCLOSURE: P Blankestijn reports research funded by Fresenius and Gambro, honoraria for lectures by Fresenius, Gambro, Solvay and Novartis; M Grooteman reports research funded by Fresenius, Gambro and Baxter; M Nubé reports research funded by Baxter and Fresenius; P ter Wee reports research funded by Abbott, Baxter, Gambro, Fresenius and Roche; honoraria for lectures received by Amgen, Roche, Genzyme, Fresenius.
Data 30.06.2011
 
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