Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: the effect of adjustment for body size.

Autor:	Davenport A; University College London, Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK. Electronic address: andrewdavenport@nhs.uk., Peters SA; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Bots ML; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Canaud B; Nephrology, Dialysis and Intensive Care Unit, Dialysis Research and Training Institute, CHRU, Montpellier, France; Dialysis Research and Training Institute, Montpellier, France., Grooteman MP; Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands., Asci G; Division of Nephrology, Ege University School of Medicine, Izmir, Turkey., Locatelli F; Department of Nephrology, Alessandro Manzoni Hospital, Lecco, Italy., Maduell F; Department of Nephrology, Hospital Clinic, Barcelona, Spain., Morena M; Dialysis Research and Training Institute, Montpellier, France; Biochemistry Laboratory, University of Montpellier, CHRU, Montpellier, France., Nubé MJ; Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands., Ok E; Division of Nephrology, Ege University School of Medicine, Izmir, Turkey., Torres F; Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain., Woodward M; University College London, Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA., Blankestijn PJ; Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2016 Jan; Vol. 89 (1), pp. 193-9. Date of Electronic Publication: 2016 Jan 04.
DOI:	10.1038/ki.2015.264
Abstrakt:	Mortality remains high for hemodialysis patients. Online hemodiafiltration (OL-HDF) removes more middle-sized uremic toxins but outcomes of individual trials comparing OL-HDF with hemodialysis have been discrepant. Secondary analyses reported higher convective volumes, easier to achieve in larger patients, and improved survival. Here we tested different methods to standardize OL-HDF convection volume on all-cause and cardiovascular mortality compared with hemodialysis. Pooled individual patient analysis of four prospective trials compared thirds of delivered convection volume with hemodialysis. Convection volumes were either not standardized or standardized to weight, body mass index, body surface area, and total body water. Data were analyzed by multivariable Cox proportional hazards modeling from 2793 patients. All-cause mortality was reduced when the convective dose was unstandardized or standardized to body surface area and total body water; hazard ratio (95% confidence intervals) of 0.65 (0.51-0.82), 0.74 (0.58-0.93), and 0.71 (0.56-0.93) for those receiving higher convective doses. Standardization by body weight or body mass index gave no significant survival advantage. Higher convection volumes were generally associated with greater survival benefit with OL-HDF, but results varied across different ways of standardization for body size. Thus, further studies should take body size into account when evaluating the impact of delivered convection volume on mortality end points. (Copyright © 2015 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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