EBPG guideline on dialysis strategies

Tattersall, James; Martín‐Malo, Alejandro; Pedrini, Luciano A.; Başçı, Alı; Canaud, Bernard; Fouque, Denis; Haage, Patrick; Könner, Klaus; Kooman, Jeroen P.; Pizzarelli, Francesco; Tordoir, Jan; Vennegoor, Marianne; Wanner, Christoph; Wee, Piet ter; Vanholder, Raymond

doi:10.1093/ndt/gfm022

Cited by 198 publications

(189 citation statements)

References 177 publications

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“…22 The fact that we did not find a difference in outcome between low-flux hemodialysis and hemodiafiltration suggests that comparison of high-flux hemodialysis with hemodiafiltration is even less likely to result in a difference in outcome.…”

Section: Discussionmentioning

confidence: 66%

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Grooteman

Dorpel

Bots

et al. 2012

Journal of the American Society of Nephrology

463

423

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In patients with ESRD, the effects of online hemodiafiltration on all-cause mortality and cardiovascular events are unclear. In this prospective study, we randomly assigned 714 chronic hemodialysis patients to online postdilution hemodiafiltration (n=358) or to continue low-flux hemodialysis (n=356). The primary outcome measure was all-cause mortality. The main secondary endpoint was a composite of major cardiovascular events, including death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, therapeutic coronary intervention, therapeutic carotid intervention, vascular intervention, or amputation. After a mean 3.0 years of follow-up (range, 0.4-6.6 years), we did not detect a significant difference between treatment groups with regard to all-cause mortality (121 versus 127 deaths per 1000 person-years in the online hemodiafiltration and low-flux hemodialysis groups, respectively; hazard ratio, 0.95; 95% confidence interval, 0.75-1.20). The incidences of cardiovascular events were 127 and 116 per 1000 person-years, respectively (hazard ratio, 1.07; 95% confidence interval, 0.83-1.39). Receiving highvolume hemodiafiltration during the trial associated with lower all-cause mortality, a finding that persisted after adjusting for potential confounders and dialysis facility. In conclusion, this trial did not detect a beneficial effect of hemodiafiltration on all-cause mortality and cardiovascular events compared with low-flux hemodialysis. On-treatment analysis suggests the possibility of a survival benefit among patients who receive high-volume hemodiafiltration, although this subgroup finding requires confirmation.

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Section: Discussionmentioning

confidence: 66%

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Grooteman

Dorpel

Bots

et al. 2012

Journal of the American Society of Nephrology

463

423

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“…111 An increase in treatment time and or frequency should be considered in patients who experience hemodynamic instability or remain hypertensive despite maximal possible fluid removal.…”

Section: Providing Adequate Duration Of Dialysismentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

161

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…28 The use of synthetic high-flux membranes should be considered to delay the longterm complication of HD therapy: amyloidosis, hyperphosphatemia, cardiovascular risk, and anemia. 29,30 However, it cannot be concluded whether possible clinical differences are based on differences in membrane flux or on membrane biocompatibility, because most of the studies did not randomize patients by membrane biocompatibility.…”

Section: Introductionmentioning

confidence: 99%

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

Knežević¹,

Djordjević²,

Radovanovic-Velickovic³

et al. 2012

Renal Failure

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Background: The quality of life in patients undergoing hemodialysis is significantly disturbed. There are data that hemodiafiltration (HDF) may be more effective than conventional hemodialysis in the removal of uremic toxins and may reduce frequency and severity of intradialytic and postdialysis adverse symptoms in patients. Also, some researchers suggest advantages of using high-flux membranes compared with low-flux. Objective: The aim of this study was to examine whether hemodialysis modality and membrane flux, independent of membrane biocompatibility, make differences in quality of life in patients. Methods: In our cross-sectional study, we evaluated 124 patients who were divided, based on therapy, into three groups: online HDF, high-flux hemodialysis, and low-flux hemodialysis. Data were collected using the Short Form-36 questionnaire combined with special questionnaire, which included demographic and clinically related questions. Results: Health-related quality of life was better in patients on HDF compared with patients on hemodialysis, especially compared with low-flux hemodialysis patients in most of the scales and in both dimensions: physical component scale and mental component scale. There were no statistically significant differences in Short Form-36 domains between high-flux hemodialysis and low-flux hemodialysis. Conclusion: Our data suggest the potential advantages of HDF with regard to influence on quality of life, which is sufficient to justify further research in prospective and longitudinal study design.

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EBPG guideline on dialysis strategies

Cited by 198 publications

References 177 publications

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes

Assessment and Management of Hypertension in Patients on Dialysis

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

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