The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy.
BACKGROUND
Hemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections.


METHODS
We used data of the 714 HD patients (age 64 ±14, 62% men, 25% Diabetes Mellitus, 7% catheters) participating in the CONvective TRAnsport STudy (CONTRAST), a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD. The events were adjudicated by an independent event committee. The risk of infectious events was compared with Cox regression for repeated events and Cox proportional hazard models. The distributions of types of infection were compared between the groups.


RESULTS
Thirty one percent of the patients suffered from one or more infections leading to hospitalization during the study (median follow-up 1.96 years). The risk for infections during the entire follow-up did not differ significantly between treatment arms (HDF 198 and HD 169 infections in 800 and 798 person-years respectively, hazard ratio HDF vs. HD 1.09 (0.88-1.34), P = 0.42. No difference was found in the occurrence of the first infectious event (either fatal, non-fatal or type specific). Of all infections, respiratory infections (25% in HDF, 28% in HD) were most common, followed by skin/musculoskeletal infections (21% in HDF, 13% in HD).


CONCLUSIONS
HDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings.


BACKGROUND
ClinicalTrials.gov NCT00205556.
Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands; Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
Claire H
CH
den Hoedt
Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
Muriel P C
MP
Grooteman
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Michiel L
ML
Bots
Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
Peter J
PJ
Blankestijn
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Ingeborg
I
van der Tweel
Academic Medical Center, Amsterdam, The Netherlands.
Neelke C
NC
van der Weerd
Medical Center Alkmaar, Alkmaar, The Netherlands.
E Lars
EL
Penne
Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
Albert H A
AH
Mazairac
Centre Hospitalier de l'Université de Montréal, St. Luc Hospital, Montréal, Canada.
Renée
R
Levesque
Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
Piet M
PM
ter Wee
Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research VU Medical Center (ICaR-VU), VU Medical Center, Amsterdam, The Netherlands.
Menso J
MJ
Nubé
Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
Marinus A
MA
van den Dorpel
D001424:Bacterial Infections / Q000453:epidemiology*; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects* / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007688:Kidneys, Artificial; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012306:Risk; D012874:Skin Diseases, Infectious / Q000453:epidemiology*