期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 33, 期 4, 页码 683-689出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfx277
关键词
anemia; chronic kidney disease; dialysis; hemodia-filtration; high-flux dialysis
资金
- AstraZeneca
- European Renal Association- European Dialysis and Transplant Association (ERA-EDTA)
- German Society of Nephrology (DGfN)
- Hexal AG
- Janssen
- Japanese Society for Peritoneal Dialysis (JSPD)
- Keryx
- Proteon
- Relypsa
- Roche
- Societa Italiana di Nefrologia (SIN)
- Spanish Society of Nephrology
- Australia: National Health & Medical Research Council (NHMRC)
- Canada: Canadian Institutes of Health Research (CIHR)
- France: Agence Nationale de la Recherche
- Thailand: Thailand Research Foundation (TRF)
- Thailand: Chulalongkorn University Matching Fund
- Thailand: King Chulalongkorn Memorial Hospital Matching Fund
- Thailand: National Research Council of Thailand (NRCT)
- UK: National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN)
- USA: National Institutes of Health (NIH)
- NIDDK [K01DK087762]
- USA: Patient-Centered Outcomes Research Institute (PCORI)
- Canada: Ontario Renal Network
- Vifor Fresenius Medical Care Renal Pharma
- Amgen
- Kyowa Hakko Kirin
- Baxter Healthcare
Background. With its convective component, hemodiafiltration (HDF) provides better middle molecule clearance compared with hemodialysis (HD) and is postulated to improve survival. A previous analysis of Dialysis Outcomes and Practice Patterns Study (DOPPS) data in 1998-2001 found lower mortality rates for high replacement fluid volume HDF versus HD. Randomized controlled trials have not shown uniform survival advantage for HDF; in secondary (non-randomized) analyses, better outcomes were observed in patients receiving the highest convection volumes. Methods. In a 'real-world' setting, we analyzed patients on dialysis >90 days from seven European countries in DOPPS Phases 4 and 5 (2009-15). Adjusted Cox regression was used to study HDF (versus HD) and mortality, overall and by replacement fluid volume. Results. Among 8567 eligible patients, 2012 (23%) were on HDF, ranging from 42% in Sweden to 12% in Germany. Median follow-up was 1.5 years during which 1988 patients died. The adjusted mortality hazard ratio (95% confidence interval) was 1.14 (1.00-1.29) for any HDF versus HD and 1.08 (0.92-1.28) for HDF > 20 L replacement fluid volume versus HD. Similar results were found for cardiovascular and infection-related mortality. In an additional analysis aiming to avoid treatment-by-indication bias, we did not observe lower mortality rates in facilities usingmore HDF (versus HD). Conclusions. Our results do not support the notion that HDF provides superior patient survival. Further trials designed to test the effect of high-volume HDF (versus lower volume HDF versus HD) on clinical outcomes are needed to adequately inform clinical practices.
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