title: Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: results from a randomized controlled trial (CONTRAST).
abstract: Resistance to erythropoiesis stimulating agents (ESA) is common in patients undergoing chronic hemodialysis (HD) treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF). In this analysis of the randomized controlled CONvective TRAnsport STudy (CONTRAST; NCT00205556), the effect of online HDF on ESA resistance and iron parameters was studied. This was a pre-specified secondary endpoint of the main trial. A 12 months' analysis of 714 patients randomized to either treatment with online post-dilution HDF or continuation of low-flux HD was performed. Both groups were treated with ultrapure dialysis fluids. ESA resistance, measured every three months, was expressed as the ESA index (weight adjusted weekly ESA dose in daily defined doses [DDD]/hematocrit). The mean ESA index during 12 months was not different between patients treated with HDF or HD (mean difference HDF versus HD over time 0.029 DDD/kg/Hct/week [-0.024 to 0.081]; P = 0.29). Mean transferrin saturation ratio and ferritin levels during the study tended to be lower in patients treated with HDF (-2.52% [-4.72 to -0.31]; P = 0.02 and -49 ng/mL [-103 to 4]; P = 0.06 respectively), although there was a trend for those patients to receive slightly more iron supplementation (7.1 mg/week [-0.4 to 14.5]; P = 0.06). In conclusion, compared to low-flux HD with ultrapure dialysis fluid, treatment with online HDF did not result in a decrease in ESA resistance.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00205556.
authors.affiliation: Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands; Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Neelke C
authors.initials: NC
authors.lastname: van der Weerd
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Claire H
authors.initials: CH
authors.lastname: Den Hoedt
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Marinus A
authors.initials: MA
authors.lastname: van den Dorpel
authors.affiliation: Department of Nephrology, Centre Hospitalier de l'Université de Montréal, St-Luc Hospital, Québec, Canada.
authors.forename: Renée
authors.initials: R
authors.lastname: Lévesque
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Albert H A
authors.initials: AH
authors.lastname: Mazairac
authors.affiliation: Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
authors.affiliation: Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: E Lars
authors.initials: EL
authors.lastname: Penne
authors.affiliation: Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter M
authors.initials: PM
authors.lastname: ter Wee
authors.affiliation: Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
mesh_terms: D004351:Drug Resistance; D005260:Female; D006397:Hematinics / Q000494:pharmacology*; D017583:Hemodiafiltration / Q000379:methods*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D007501:Iron
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