Effects of high-volume online mixed-hemodiafiltration on anemia management in dialysis patients

Autor: Carlo Barbieri, Annalisa Feliciani, Gudrun Klein, Bernard Canaud, Astrid Feuersenger, Jenny Pham, Adam M Zawada, Stefano Stuard, Adelheid Gauly, Anke Winter, Melanie Wolf, L. Pedrini, Pio Ruggiero
Přispěvatelé: Fresenius Medical Care, Fresenius Medical Care [Bad Homburg], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Physiology
medicine.medical_treatment
030232 urology & nephrology
Normal Distribution
030204 cardiovascular system & hematology
[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
Biochemistry
Hemoglobins
0302 clinical medicine
Blood Flow
Medicine and Health Sciences
Fluids
Multidisciplinary
integumentary system
Physics
Anemia
Hematology
Middle Aged
3. Good health
Body Fluids
Separation Processes
Blood
Nephrology
Physical Sciences
Medicine
Female
Anatomy
Research Article
Adult
medicine.medical_specialty
States of Matter
Science
Hemodiafiltration
Dialysis patients
Research and Analysis Methods
Models
Biological
03 medical and health sciences
Internal medicine
Hemofiltration
Medical Dialysis
medicine
Humans
Hemoglobin
Dialysis
Aged
Retrospective Studies
business.industry
MESH: Anemia/blood
Anemia/complications
Hematinics/administration & dosage
Kidney Failure
Chronic/blood
Kidney Failure
Chronic/therapy
Biology and Life Sciences
Proteins
Retrospective cohort study
medicine.disease
Probability Theory
Probability Distribution
Anemia management
Comorbidity
Hematinics
Kidney Failure
Chronic
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Filtration
Mathematics
Follow-Up Studies
Zdroj: PLoS ONE
PLoS ONE, Vol 14, Iss 2, p e0212795 (2019)
PLoS ONE, Public Library of Science, 2019, 14 (2), pp.e0212795. ⟨10.1371/journal.pone.0212795⟩
ISSN: 1932-6203
Popis: BackgroundAnemia is a major comorbidity of patients with end-stage renal disease and poses an enormous economic burden to health-care systems. High dose erythropoiesis-stimulating agents (ESAs) have been associated with unfavorable clinical outcomes. We explored whether mixed-dilution hemodiafiltration (Mixed-HDF), based on its innovative substitution modality, may improve anemia outcomes compared to the traditional post-dilution hemodiafiltration (Post-HDF).MethodsWe included 174 adult prevalent dialysis patients (87 on Mixed-HDF, 87 on Post-HDF) treated in 24 NephroCare dialysis centers between January 2010 and August 2016 into this retrospective cohort study. All patients were dialyzed three times per week and had fistula/graft as vascular access. Patients were matched at baseline and followed over a one-year period. The courses of hemoglobin levels (Hb) and monthly ESA consumption were compared between the two groups with linear mixed models.ResultsMean baseline Hb was 11.9±1.3 and 11.8±1.1g/dl in patients on Mixed- and Post-HDF, respectively. While Hb remained stable in patients on Mixed-HDF, it decreased slightly in patients on Post-HDF (at month 12: 11.8±1.2 vs 11.1±1.2g/dl). This tendency was confirmed by our linear mixed model (p = 0.0514 for treatment x time interaction). Baseline median ESA consumption was 6000 [Q1:0;Q3:16000] IU/4 weeks in both groups. Throughout the observation period ESA doses tended to be lower in the Mixed-HDF group (4000 [Q1:0;Q3:16000] vs 8000 [Q1:0;Q3:20000] IU/4 weeks at month 12; p = 0.0791 for treatment x time interaction). Sensitivity analyses, adjusting for differences not covered by matching at baseline, strengthened our results (Hb: p = 0.0124; ESA: p = 0.0687).ConclusionsResults of our explorative study suggest that patients on Mixed-HDF may have clinical benefits in terms of anemia management. This may also have a beneficial economic impact. Future studies are needed to confirm our hypothesis-generating results and to provide additional evidence on the potential beneficial effects of Mixed-HDF.
Databáze: OpenAIRE
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