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 Soler, Ferran Torres, Josep M. Campistol, Alberto Martinez-Castelao

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    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. Copyright © 2013 by the American Society of Nephrology.
    Original languageEnglish
    Pages (from-to)487-497
    JournalJournal of the American Society of Nephrology
    Volume24
    Issue number3
    DOIs
    Publication statusPublished - 28 Feb 2013

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  • Cite this

    Maduell, F., Moreso, F., Pons, M., Ramos, R., Mora-Macià, J., Carreras, J., Soler, J., Torres, F., Campistol, J. M., & Martinez-Castelao, A. (2013). High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. Journal of the American Society of Nephrology, 24(3), 487-497. https://doi.org/10.1681/ASN.2012080875