High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients
Francisco Maduell,Francesc Moreso,Mercedes Pons,Rosa Ramos,Josep Mora-Macià,Jordi Carreras,Jordi Vallespir Soler,Ferran Torres,Josep M. Campistol,Alberto Martínez-Castelao +9 more
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TLDR
High-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis in patients with ESRD and the estimated number needed to treat suggested that switching eight patients from he modialysis to OL- HDF may prevent one annual death.Abstract:
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.read more
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Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Garabed Eknoyan,Gerald J. Beck,Alfred K. Cheung,John T. Daugirdas,Tom Greene,John W. Kusek,Michael Allon,James L. Bailey,James A. Delmez,Thomas A. Depner,Johanna T. Dwyer,Andrew S. Levey,Nathan W. Levin,Edgar L. Milford,Daniel B. Ornt,Michael V. Rocco,Gerald Schulman,Steve J. Schwab,Brendan P. Teehan,Robert D. Toto +19 more
TL;DR: Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.
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Epidemiology of cardiovascular disease in chronic renal disease
TL;DR: The risk of cardiovascular disease in patients with chronic renal disease appears to be far greater than in the general population as mentioned in this paper, even after stratification by age, gender, race, and the presence or absence of diabetes.
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Epidemiology of cardiovascular disease in chronic renal disease.
TL;DR: Patients with chronic renal disease should be considered in the highest risk group for subsequent cardiovascular events, and patients who develop clinical manifestations of cardiac failure should be evaluated for cardiovascular disease.
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Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS
Bernard Canaud,Jennifer L. Bragg-Gresham,Mark R. Marshall,S. Desmeules,Brenda W. Gillespie,Tom Depner,Preston S. Klassen,Friedrich K. Port +7 more
TL;DR: Observational results suggest that HDF may improve patient survival independently of its higher dialysis dose, and the potential benefits of HDF must be tested by controlled clinical trials before recommendations can be made for clinical practice.
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