title: Acetate-free biofiltration reduces intradialytic hypotension: a European multicenter randomized controlled trial.
abstract: BACKGROUND
  Intradialytic hypotension (IH) is a common complication of bicarbonate hemodialysis (BD) and contributes to the intolerance of dialysis and the high cardiovascular morbidity and mortality among dialysis patients, the risk of which can be contained by convective therapies.
  
  
  OBJECTIVE
  To assess whether acetate-free biofiltration (AFB), a hemodiafiltration technique found to improve intradialytic cardiovascular stability in short-term studies, can influence long-term IH rates, predialysis systolic blood pressure (SBP), cardiovascular morbidity and mortality by comparison with BD, we analyzed data from a randomized controlled trial enrolling 371 new-to-dialysis patients, 194 on BD and 177 on AFB.
  
  
  RESULTS
  During a 3-year follow-up, AFB carried a significantly lower risk of IH (incidence rate ratio 0.60 (95% CI 0.53-0.68), p < 0.0001). SBP dropped on AFB (p = 0.01), while it did not change on BD. Cardiovascular morbidity and mortality were similar between AFB and BD.
  
  
  CONCLUSIONS
  AFB carries a lower long-term IH rate and reduces SBP by comparison with BD.
authors: Division of Nephrology, Azienda Ospedaliera Universitaria Integrata-Verona, Verona, Italy. nicola.tessitore@ospedaleuniverona.it
authors: Nicola
authors: N
authors: Tessitore
authors: Antonio
authors: A
authors: Santoro
authors: Giovanni Oliviero
authors: GO
authors: Panzetta
authors: Volker
authors: V
authors: Wizemann
authors: Rafael
authors: R
authors: Perez-Garcia
authors: Jorge
authors: J
authors: Martinez Ara
authors: Bruno
authors: B
authors: Perrone
authors: William
authors: W
authors: Mantovani
authors: Albino
authors: A
authors: Poli
mesh_terms: D000368:Aged; D001639:Bicarbonates / Q000737:chemistry; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D005060:Europe; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects*; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D015312:Hemodialysis Solutions