title: High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.
abstract: Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.
authors: Department of Nephrology and Renal Transplantation, Hospital Clinic, University of Barcelona, Villarroel, 170 - 08036 Barcelona, Spain. fmaduell@clinic.ub.es
authors: Francisco
authors: F
authors: Maduell
authors: Francesc
authors: F
authors: Moreso
authors: Mercedes
authors: M
authors: Pons
authors: Rosa
authors: R
authors: Ramos
authors: Josep
authors: J
authors: Mora-Macià
authors: Jordi
authors: J
authors: Carreras
authors: Jordi
authors: J
authors: Soler
authors: Ferran
authors: F
authors: Torres
authors: Josep M
authors: JM
authors: Campistol
authors: Alberto
authors: A
authors: Martinez-Castelao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome