TY - JOUR
T1 - Mortality reduction by post-dilution online-haemodiafiltration
T2 - A cause-specific analysis
AU - Nubé, Menso J.
AU - Peters, Sanne A.E.
AU - Blankestijn, Peter J.
AU - Canaud, Bernard
AU - Davenport, Andrew
AU - Grooteman, Muriel P.C.
AU - Asci, Gulay
AU - Locatelli, Francesco
AU - Maduell, Francisco
AU - Morena, Marion
AU - Ok, Ercan
AU - Torres, Ferran
AU - Bots, Michiel L.
AU - Moreso, Francesc
AU - Pons, Mercedes
AU - Ramos, Rosa
AU - Mora-Macià, Josep
AU - Carreras, Jordi
AU - Soler, Jordi
AU - Campistol, Josep M.
AU - Martinez-Castelao, Alberto
AU - Insensé, B.
AU - Perez, C.
AU - Feliz, T.
AU - Barbetta, M.
AU - Soto, C.
AU - Mora, J.
AU - Juan, A.
AU - Ibrik, O.
AU - Foraster, A.
AU - Nin, J.
AU - Fernández, A.
AU - Arruche, M.
AU - Sánchez, C.
AU - Vidiella, J.
AU - Barbosa, F.
AU - Chiné, M.
AU - Hurtado, S.
AU - Llibre, J.
AU - Ruiz, A.
AU - Serra, M.
AU - Salvó, M.
AU - Poyuelo, T.
AU - Maduell, F.
AU - Carrera, M.
AU - Fontseré, N.
AU - Arias, M.
AU - Ramirez, A.
AU - Aguilera, J.
AU - Ríos, J.
N1 - Publisher Copyright:
© 2016 The Author.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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.
AB - 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.
KW - cardiovascular disease
KW - convection volume
KW - haemodiafiltration
KW - meta-analysis
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85017283194&partnerID=8YFLogxK
U2 - 10.1093/ndt/gfw381
DO - 10.1093/ndt/gfw381
M3 - Article
C2 - 28025382
AN - SCOPUS:85017283194
VL - 32
SP - 548
EP - 555
IS - 3
ER -
