1. Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis
- Author
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Nubé, Menso J., Peters, Sanne A E, Blankestijn, Peter J., Canaud, Bernard, Davenport, Andrew, Grooteman, Muriel P C, Asci, Gulay, Locatelli, Francesco, Maduell, Francisco, Morena, Marion, Ok, Ercan, Torres, Ferran, Bots, Michiel L., Moreso, Francesc, Pons, Mercedes, Ramos, Rosa, Mora-Macià, Josep, Carreras, Jordi, Soler, Jordi, Campistol, Josep M., Martinez-Castelao, Alberto, Insensé, B., Perez, C., Feliz, T., Barbetta, M., Soto, C., Mora, J., Juan, A., Ibrik, O., Foraster, A., Nin, J., Fernández, A., Arruche, M., Sánchez, C., Vidiella, J., Barbosa, F., Chiné, M., Hurtado, S., Llibre, J., Ruiz, A., Serra, M., Salvó, M., Poyuelo, T., Maduell, F., Carrera, M., Fontseré, N., Arias, M., Merín, A., Ribera, L., Galceran, J. M., Mòdol, J., Moliner, E., Ramirez, A., Aguilera, J., Alvarez, M., De La Torre, B., Molera, M., Casellas, J., Martín, G., Andres, E., Coll, E., Valles, M., Martínez, C., Castellote, E., Casals, J. M., Gabàs, J., Romero, M., Martinez-Castelao, A., Fulladosa, X., Ramirez-Arellano, M., Fulquet, M., Pelegrí, A., El Manouari, M., Ramos, N., Bartolomé, J., Sans, R., Fernández, E., Sarró, F., Compte, T., Marco, F., Mauri, R., Bronsoms, J., Arnaiz, J. A., Beleta, H., Pejenaute, A., Ríos, J., Lara, J., Ter Wee, P. M., Van Den Dorpel, M. A., Dorval, M., Lévesque, R., Koopman, M. G., Konings, C. J A M, Haanstra, W. P., Kooistra, M., Van Jaarsveld, B., Noordzij, T., Feith, G. W., Peltenburg, H. G., Van Buren, M., Offerman, J. J G, Hoogeveen, E. K., De Heer, F., Van De Ven, P. J., Kremer Hovinga, T. K., Bax, W. A., Groeneveld, J. O., Lavrijssen, A. T J, Schrander-Van Der Meer, A. M., Reichert, L. J M, Huussen, J., Rensma, P. L., Schrama, Y., Van Hamersvelt, H. W., Boer, W. H., Van Kuijk, W. H., Vervloet, M. G., Wauters, I. M P M J, Sekse, I., Toz, Huseyin, Ok, Ebru Sevinc, Kircelli, Fatih, Yilmaz, Mumtaz, Hur, Ender, Demirci, Meltem Sezis, Demirci, Cenk, Duman, Soner, Basci, Ali, Adam, Siddig Momin, Isik, Ismet Onder, Zengin, Murat, Suleymanlar, Gultekin, Yilmaz, Mehmet Emin, Ergin, Mehmet Ozkahya Pinar, Sagdic, Alfert, Kayali, Erkan, Boydak, Can, Colak, Taskin, Caliskan, Sihli, Kaplan, Hakan, Ulas, Hasibe, Kirbiyik, Sait, Berktas, Hakan, Dilbaz, Necati, Cristol, Jean Paul, Leray-Moragues, Hélène, Chenine, Leïla, Picot, Marie Christine, Jaussent, Audrey, Belloc, Claire, Lagarrigue, Mélodie, Chalabi, Lotfi, Debure, Alain, Ouziala, Messaoud, Lefevre, Jean Jacques, Thibaudin, Damien, Mohey, Hesham, Broyet, Christian, Afiani, Aida, Serveaux, Marie Odile, Patrier, Laure, Maurice, François, Rivory, Jean Pierre, Nicoud, Philippe, Durand, Claude, Normand, Michel, Seigneuric, Bruno, Magnant, Eric, Azzouz, Lynda, Islam, Mohamed Shariful, Vido, Sandor, Nzeyimana, Hilaire, Simonin, Danièle, Azymah, Yamina, Farah, Ibrahim, Coindre, Jean Philippe, Puyoo, Olivier, Chabannier, Marie Hélène, Ibos, Richard, Rouleau, Fabienne, Vela, Carlos, Joule, Josiane, Combarnous, François, Turc-Baron, Cécile, Ducret, Francis, Pointet, Philippe, Rey, Isabelle, Potier, Jacky, Bendini, Jean Christophe, Perrin, Franck, Kunz, Kristian, Lefrancois, Gaëlle, Colin, Angélique, Parahy, Sophie, Dancea, Irima, Coupel, Stéphanie, Testa, Angelo, Brunet, Philippe, Lebrun, Gaétan, Jaubert, Dominique, Delcroix, Catherine, Lavainne, Frédéric, Lefebvre, Anne, Guillodo, Marie Paule, Le Grignou, Dominique, Djema, Assia, Maaz, Mehadji, Chiron, Sylvie, Hoffmann, Maxime, Depraetre, Pascale, Haddj-Elmrabet, Atman, Joyeux, Véronique, Fleury, Dominique, Vrigneaud, Laurence, Lemaitre, Vincent, Aguilera, Didier, Guerraoui, Abdallah, Cremault, Alain, Laradi, Achour, Babinet, Francois, VU University Medical Center [Amsterdam], University of Oxford [Oxford], University Medical Center [Utrecht], Fresenius Medical Care Deutschland, University College of London [London] (UCL), Ege university, Alessandro Manzoni Hospital, Hospital Clinic Barcelona, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Universitat Autònoma de Barcelona (UAB), Ege Üniversitesi, Nephrology, ICaR - Circulation and metabolism, Herrada, Anthony, and University of Oxford
- Subjects
Male ,medicine.medical_specialty ,030232 urology & nephrology ,Hemodiafiltration ,030204 cardiovascular system & hematology ,haemodiafiltration ,Convection ,Lower risk ,Sudden death ,convection volume ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,haemo-diafiltration ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,cardiovascular disease ,Cause of Death ,Internal medicine ,Journal Article ,medicine ,Humans ,Intensive care medicine ,Aged ,Proportional Hazards Models ,Randomized Controlled Trials as Topic ,Transplantation ,integumentary system ,business.industry ,Mortality rate ,Hazard ratio ,Middle Aged ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,mortality ,Confidence interval ,3. Good health ,meta-analysis ,Cardiovascular Diseases ,Nephrology ,Meta-analysis ,Cardiology ,Number needed to treat ,Kidney Failure, Chronic ,Female ,business - Abstract
WOS: 000398117600023, PubMed ID: 28025382, Background. From an individual participant data (IPD) meta-analysis from four randomized controlled trials comparing haemodialysis (HD) with post-dilution online-haemodiafiltration (ol-HDF), previously it appeared that HDF decreases all-cause mortality by 14% (95% confidence interval 25; 1) and fatal cardiovascular disease (CVD) by 23% (39; 3). Significant differences were not found for fatal infections and sudden death. So far, it is unclear, however, whether the reduced mortality risk of HDF is only due to a decrease in CVD events and if so, which CVD in particular is prevented, if compared with HD. Methods. The IPD base was used for the present study. Hazard ratios and 95% confidence intervals for cause-specific mortality overall and in thirds of the convection volume were calculated using the Cox proportional hazard regression models. Annualized mortality and numbers needed to treat (NNT) were calculated as well. Results. Besides 554 patients dying from CVD, fatal infections and sudden death, 215 participants died from 'other causes', such as withdrawal from treatment and malignancies. In this group, the mortality risk was comparable between HD and ol-HDF patients, both overall and in thirds of the convection volume. Subdivision of CVD mortality in fatal cardiac, non-cardiac and unclassified CVD showed that ol-HDF was only associated with a lower risk of cardiac casualties [0.64 (0.61; 0.90)]. Annual mortality rates also suggest that the reduction in CVD death is mainly due to a decrease in cardiac fatalities, including both ischaemic heart disease and congestion. Overall, 32 and 75 patients, respectively, need to be treated by high-volume HDF (HV-HDF) to prevent one all-cause and one CVD death, respectively, per year. Conclusion. The beneficial effect of ol-HDF on all-cause and CVD mortality appears to be mainly due to a reduction in fatal cardiac events, including ischaemic heart disease as well as congestion. In HV-HDF, the NNT to prevent one CVD death is 75 per year., EuDial working group; European Nephrology and Dialysis Institute; Catalan Society of Nephrology; Fresenius Medical Care; Dutch Kidney Foundation [C02.2019]; Fresenius Medical Care, Netherlands; Gambro Lundia AB, Sweden; Dr E.E. Twiss Fund; International Society of Nephrology/Baxter Extramural Grant Program; Netherlands Organization for Health Research and DevelopmentNetherlands Organization for Health Research and Development [170882802]; national grant from the Health Ministry (Programme Hospitalier de Recherche Clinique, PHRC); Gambro through the Catalan Society of Nephrology; Roche Netherlands, The HDF Pooling project was designed, conducted and analysed independently of the financial contributors of the individual studies as listed below. Study data were collected and retained by the investigators and were not available for the financial contributors of the individual studies. S.A.E.P. and the meetings of the representatives of the combined authors of the four studies were financially supported by the EuDial working group. EuDial is an official working group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA, http://era-edta.org/eudial/European_Dialysis_Working_Group.html). No industry funding was received for any part of or activity related to the present analysis.; The Turkish HDF study was supported by European Nephrology and Dialysis Institute with an unrestricted grant. The study was performed in Fresenius Medical Care haemodialysis clinics in Turkey. ESHOL was supported by The Catalan Society of Nephrology and by grants from Fresenius Medical Care and Gambro through the Catalan Society of Nephrology. The CONTRAST study was supported by a grant from the Dutch Kidney Foundation (Nierstichting Nederland Grant C02.2019), and unrestricted grants from Fresenius Medical Care, Netherlands, and Gambro Lundia AB, Sweden. Additional support was received from the Dr E.E. Twiss Fund, Roche Netherlands, the International Society of Nephrology/Baxter Extramural Grant Program, and the Netherlands Organization for Health Research and Development (ZONMw Grant 170882802). The French HDF study was supported by a national grant from the Health Ministry (Programme Hospitalier de Recherche Clinique, PHRC) as a means to improve care and outcome of elderly chronic disease patients.
- Published
- 2017
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