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Titolo	Mortality risk for patients receiving hemodiafiltration versus hemodialysis.
Autore	T. Jirka, S. Cesare, A. Di Benedetto, M. Perera Chang, P. Ponce, N. Richards, C. Tetta, L. Vaslaky
Referenza	Kidney International 2006; 70: 1524
Contenuto	To the Editor: Canaud et al.1 reported a significant 35% lower mortality risk with high-efficiency hemodiafiltration (HDF) compared to low-flux hemodialysis. Patients on HDF were slightly older, significantly heavier, and longer on renal replacement therapy (higher co-morbidity). Thus, they were possibly selected for HDF because of their higher risk profile. We evaluated HDF data prospectively collected in EuCliD2 from 56 clinics in Czech Republic, Hungary, Italy, and UK, all belonging to an International dialysis provider network. To reduce bias related to different dialysis doses, only patients on three times a week schedule achieving an eKt/VX1.20 were considered. Out of 2564 prevalent patients, 394 were treated with HDF and 2170 with hemodialysis over 12 months. Similarly, patients on HDF were heavier (67.6 versus 65.9 kg, P¼0.03) and longer on renal replacement therapy (6.6174.94 versus 4.9775.05 years, Po0.001); however, they were significantly younger (52.7716.3 versus 59.7716.1 years, Po0.001). Furthermore, they were more likely to be diabetic (20.3 versus 18.3%) or affected by neoplasm (8.4 versus 6.7%). High-flux polysulfone was usually used. Data on replacement volume is not currently available but, as on-line HDF was standard, volumes are likely to be high (15-25 l). HDF resulted in a significant 42.7% reduction in mortality risk (odds ratio: 0.573; 95% confidence interval: 0.377-0.873). After adjustment for age, gender, co-morbidities, and time on renal replacement therapy, mortality risk reduction was 35.3% (odds ratio: 0.647; 95% confidence interval: 0.419-0.991) and remained significant. In conclusion, our data confirm the results of Canaud et al.1 However, epidemiological evaluations have limitations. The potential survival benefit of HDF must be tested by controlled clinical trials.
Data	13.10.2006

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