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The effect of on-line high-flux hemofiltration versus low-flux hemodialysis on mortality in chronic kidney failure: a small randomized controlled trial.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2008 Sep; Vol. 52 (3), pp. 507-18. Date of Electronic Publication: 2008 Jul 09. - Publication Year :
- 2008
-
Abstract
- Background: Given the paucity of prospective randomized controlled trials assessing comparative performances of different dialysis techniques, we compared on-line high-flux hemofiltration (HF) with ultrapure low-flux hemodialysis (HD), assessing survival and morbidity in patients with end-stage renal disease (ESRD).<br />Study Design: An investigator-driven, prospective, multicenter, 3-year-follow-up, centrally randomized study with no blinding and based on the intention-to-treat principle.<br />Setting & Participants: Prevalent patients with ESRD (age, 16 to 80 years; vintage > 6 months) receiving renal replacement therapy at 20 Italian dialysis centers.<br />Interventions: Patients were centrally randomly assigned to HD (n = 32) or HF (n = 32).<br />Outcomes & Measurements: All-cause mortality, hospitalization rate for any cause, prevalence of dialysis hypotension, standard biochemical indexes, and nutritional status. Analyses were performed using the multivariate analysis of variance and Cox proportional hazard method.<br />Results: There was significant improvement in survival with HF compared with HD (78%, HF versus 57%, HD) at 3 years of follow-up after allowing for the effects of age (P = 0.05). End-of-treatment Kt/V was significantly higher with HD (1.42 +/- 0.06 versus 1.07 +/- 0.06 with HF), whereas beta(2)-microglobulin levels remained constant in HD patients (33.90 +/- 2.94 mg/dL at baseline and 36.90 +/- 5.06 mg/dL at 3 years), but decreased significantly in HF patients (30.02 +/- 3.54 mg/dL at baseline versus 23.9 +/- 1.77 mg/dL; P < 0.05). The number of hospitalization events for each patient was not significantly different (2.36 +/- 0.41 versus 1.94 +/- 0.33 events), whereas length of stay proved to be significantly shorter in HF patients compared with HD patients (P < 0.001). End-of-treatment body mass index decreased in HD patients, but increased in HF patients. Throughout the study period, the difference in trends of intradialytic acute hypotension was statistically significant, with a clear decrease in HF (P = 0.03).<br />Limitations: This is a small preliminary intervention study with a high dropout rate and problematic generalizability.<br />Conclusion: On-line HF may improve survival independent of Kt/V in patients with ESRD, with a significant decrease in plasma beta(2)-microglobulin levels and increased body mass index. A larger study is required to confirm these results.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Blood Pressure
Body Mass Index
Female
Follow-Up Studies
Hemofiltration adverse effects
Hospitalization statistics & numerical data
Humans
Hypotension etiology
Kidney Failure, Chronic blood
Kidney Failure, Chronic physiopathology
Male
Middle Aged
Renal Dialysis adverse effects
Serum Albumin metabolism
Survival Analysis
beta 2-Microglobulin blood
Hemofiltration methods
Kidney Failure, Chronic mortality
Kidney Failure, Chronic therapy
Renal Dialysis methods
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 52
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 18617304
- Full Text :
- https://doi.org/10.1053/j.ajkd.2008.05.011