1. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly
- Author
-
Marion Morena, Audrey Jaussent, Lotfi Chalabi, Hélène Leray-Moragues, Leila Chenine, Alain Debure, Damien Thibaudin, Lynda Azzouz, Laure Patrier, Francois Maurice, Philippe Nicoud, Claude Durand, Bruno Seigneuric, Anne-Marie Dupuy, Marie-Christine Picot, Jean-Paul Cristol, Bernard Canaud, Aida Afiani, Didier Aguilera, Yamina Azymah, Francois Babinet, Claire Belloc, Jean- Christophe Bendini, Christian Broyet, Philippe Brunet, Marie-Hélène Chabannier, Leïla Chenine, Sylvie Chiron, Jean-Philippe Coindre, Angélique Colin, François Combarnous, Stéphanie Coupel, Alain Cremault, Irima Dancea, Catherine Delcroix, Pascale Depraetre, Assia Djema, Francis Ducret, Ibrahim Farah, Dominique Fleury, Abdallah Guerraoui, Marie-Paule Guillodo, Atman Haddj-Elmrabet, Maxime Hoffmann, Richard Ibos, Mohamed Shariful Islam, Dominique Jaubert, Josiane Joule, Véronique Joyeux, Kristian Kunz, Mélodie Lagarrigue, Achour Laradi, Frédéric Lavainne, Dominique Le Grignou, Gaétan Lebrun, Anne Lefebvre, Jean-Jacques Lefevre, Gaëlle Lefrancois, Vincent Lemaitre, Mehadji Maaz, Eric Magnant, François Maurice, Hesham Mohey, Michel Normand, Hilaire Nzeyimana, Messaoud Ouziala, Sophie Parahy, Franck Perrin, Philippe Pointet, Jacky Potier, Olivier Puyoo, Isabelle Rey, Jean-Pierre Rivory, Fabienne Rouleau, Marie-Odile Serveaux, Danièle Simonin, Angelo Testa, Cécile Turc-Baron, Carlos Vela, Sandor Vido, Laurence Vrigneaud, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), CHU Saint-Etienne, Service de Néphrologie - Immunologie Clinique [Toulouse], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse]-PRES Université de Toulouse, Département de biochimie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Université de Montpellier (UM), Herrada, Anthony, and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-PRES Université de Toulouse
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,030232 urology & nephrology ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Kidney ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,Risk of mortality ,Prospective Studies ,Prospective cohort study ,ComputingMilieux_MISCELLANEOUS ,Aged, 80 and over ,Age Factors ,3. Good health ,Hospitalization ,Treatment Outcome ,Nephrology ,Female ,Kidney Diseases ,France ,Hemodialysis ,medicine.symptom ,safety ,medicine.medical_specialty ,Metabolic bone disease ,03 medical and health sciences ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Intensive care medicine ,Adverse effect ,Geriatric Assessment ,Aged ,hemodiafiltration ,intradialytic tolerance ,business.industry ,medicine.disease ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,mortality ,cardiovascular risk biomarkers ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Quality of Life ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,chronic kidney disease ,Muscle cramp - Abstract
Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30-day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux hemodialysis and online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a statistical unit according to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of metabolic bone disease biomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux hemodialysis in the elderly.
- Published
- 2017