Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study

Ok, Ercan; Aşçı, Gülay; Töz, Hüseyin; Ok, Ebru Sevinç; Kırçelli, Fatih; Yılmaz, Mümtaz; Hür, Ender; Demirci, Meltem Seziş; Demirci, Cenk; Duman, Soner; Başçı, Alı; Adam, Sıddig Momin; Isık, Ismet Onder; Zengin, Murat; Süleymanlar, Gültekin; Yılmaz, Mehmet Emin; Özkahya, Mehmet

doi:10.1093/ndt/gfs407

Cited by 427 publications

(457 citation statements)

References 28 publications

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“…Post hoc analyses of three large randomized controlled trials-CONTRAST (16), the Turkish HDF Study (29), and ESHOL (Estudio de Supervivencia de Hemodiafiltración On-Line) (30)-comparing HDF to HD in terms of mortality and cardiovascular events found a relation between high convection volumes and lower mortality risk. We did not find that high convection volumes were related to rate of change of LVM, EF, and PWV.…”

Section: Convection Volumementioning

confidence: 99%

A Randomized Trial of Hemodiafiltration and Change in Cardiovascular Parameters

Mostovaya¹,

Bots

Dorpel

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objective Increased left ventricular mass (LVM), low ventricular ejection fraction (EF), and high pulse-wave velocity (PWV) relate to overall and cardiovascular mortality in patients with ESRD. The aim of this study was to determine the effect of online hemodiafiltration (HDF) versus low-flux hemodialysis (HD) on LVM, EF, and PWV.Design, setting, participants, & measurements Echocardiography was used to assess LVM and EF in 342 patients in the CONvective TRAnsport STudy followed for up to 4 years. PWV was measured in 189 patients for up to 3 years. Effect of HDF versus HD on LVM, EF, and PWV was evaluated using linear mixed models.Results Patients had a mean age of 63 years, and 61% were male. At baseline, median LVM was 227 g (interquartile range [IQR], 183-279 g), and median EF was 65% (IQR, 55%-72%). Median PWV was 9.8 m/s (IQR, 7.5-12.0 m/s). There was no significant difference between the HDF and HD treatment groups in rate of change in LVM (HDF: change, 20.9 g/yr [95% confidence interval (95% CI), 28.9 to 7.7 g]; HD: change, 12.5 g/yr [95% CI, 23.0 to 27.5 g]; P for difference=0. Conclusions Treatment with online HDF did not affect changes in LVM, EF, or PWV over time compared with HD.

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Section: Convection Volumementioning

confidence: 99%

A Randomized Trial of Hemodiafiltration and Change in Cardiovascular Parameters

Mostovaya¹,

Bots

Dorpel

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…In the case of ESHOL, this was both in the 23.1-25.5 L/treatment cohort and in the >25.4 L/treatment cohort [7] . In CON-TRAST, benefit was seen in the >21.95 L/treatment cohort [8] and in the Turkish study >19.5 L/treatment [9] . The true benefit delivered by HDF remains unclear as caution must be taken when interpreting data from such analysis.…”

Section: Clinical Outcomes In Hd: What Progress Have We Made?mentioning

confidence: 86%

Effects of Expanded Hemodialysis Therapy on Clinical Outcomes

Mitra

Kharbanda

2017

Expanded Hemodialysis: Innovative Clinical Approach in Dialysis

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The invention of dialysis has been a phenomenal advance in the treatment of kidney failure. The introduction of artificial kidneys in clinical care remains one of the most successful lifesaving interventions in modern medicine. Its glory, however, has been tempered by poor long-term outcomes and a negative qualitative impact on the lives of patients who suffer from an extremely complex, burdensome, and restricted life on dialysis. There remains a huge gap in patient well-being and outcomes between artificial kidney treatments and kidney transplantation. The inadequacy of dialysis, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules in chronic kidney disease, which are poorly removed by current dialytic treatment modalities. Incremental benefits observed through alternative strategies such as high volume hemodiafiltration, high frequency, and expanded hemodialysis (HD) schedules have had limited success, due to a host of organizational, complex technology need and human factor barriers. Expanded HD (HDx) therapy offers a novel blood purification technology, with the use of high retention onset (HRO) membranes designed to achieve a superior spectrum of solute waste removal in uremia. Limited studies have demonstrated the potential benefit of HRO membranes in reducing cardiovascular risk, vascular calcification, and inflammation commonly associated with the "residual uremic syndrome" and patient symptom burden. Robust and efficient clinical trials are now required to establish the rationale and impact of HDx therapy in driving improvements in both physician-and patient-directed clinical goals and outcomes in dialysis.

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“…Whether HDF reduces mortality is currently a matter of debate. The CONTRAST [15] and the Turkish online hemodiafiltration study [16] have both shown no difference in mortality between HD and online HDF in adult patients. However, patients, who received a convective volume of >15 l (CONTRAST) or 17.4 l (Turkish online hemodiafiltration study), had a significantly lower mortality rate.…”

Section: Introductionmentioning

confidence: 94%

Nocturnal intermittent hemodialysis

Thumfart

Müller

2014

Pediatr Nephrol

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Preemptive renal transplantation is the method of choice for end stage renal disease in childhood and adolescence. However, without preemptive transplantation, waiting time for kidney transplantation might exceed several years. The poor quality of life and the extremely high morbidity and mortality rates of dialysis patients have led to the development of intensified hemodialysis programs in which the modes of dialysis (short daily, nocturnal intermittent or daily nocturnal) are different. Such programs have been shown to significantly improve several uremia-associated parameters, such as blood pressure, phosphate control, anemia and growth retardation, in both adult and pediatric (children and adolescents) patients and lead to a reduction in medications, including phosphate binders, erythropoietin and antihypertensive agents. Fluid limitations and dietary restrictions can also be lifted. With respect to psychosocial rehabilitation and quality of life, nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs. Experiences and practical approaches of our own in-center nocturnal intermittent hemodialysis program in the light of the recent publications are described in this review.

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Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study

Abstract: The composite of all-cause mortality and nonfatal cardiovascular event rate was not different in the OL-HDF and in the high-flux HD groups. In a post hoc analysis, OL-HDF treatment with substitution volumes over 17.4 L was associated with better cardiovascular and overall survival.

Cited by 427 publications

References 28 publications

A Randomized Trial of Hemodiafiltration and Change in Cardiovascular Parameters

A Randomized Trial of Hemodiafiltration and Change in Cardiovascular Parameters

Effects of Expanded Hemodialysis Therapy on Clinical Outcomes

Nocturnal intermittent hemodialysis

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