title: PARAMETERS OF HEMODIALYSIS ADEQUACY AND PATIENTS' SURVIVAL DEPENDING ON TREATMENT MODALITIES.
abstract: BACKGROUND
  Retrospective studies showed that hemodiafiltration was associated with a reduced risk of mortality compared with standard hemodialysis in the patients with end-stage renal disease. Recently, a few prospective randomized clinical trials found no advantage in survival with hemodiafiltration as compared with high-flux hemodialysis and low-flux hemodialysis. The aim of this study was to compare the parameters of hemodialysis adequacy and two-year survival of patients depending on the modality of hemodialysis.
  
  
  METHODS
  A total of 159 hemodialysis patients were divided into 3 groups according to the type of hemodialysis treatment: group A - low-flux hemodialysis, group B - high-flux hemodialysis, and group C - hemodiafiltration. All patients had the same duration of hemodialysis sessions. The analysis included average one-year biochemical parameters, and two-year survival of patients.
  
  
  RESULTS
  The patients on hemodiafiltration were significantly younger, they had longer dialysis vintage and higher index of dialysis adequancy as compared with the patients on low-flux hemodialysis and high-flux hemodialysis, but without a difference between the two latter groups. Compared to the patients on low-flux hemodialysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly higher hemoglobin value with less frequent erythropoietin stimulating agent use. According to Kaplan-Meier survival analysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly better two-year survival than the patients on low-flux hemodialysis. Cox proportional hazards model confirmed that high-flux hemodialysis caused a significantly lower relative risk of mortality (56% reduction) compared to low-flux hemodialysis (hazard ratio 0.44; P=0.026), and hemodiafiltration caused a 58% reduction in the relative risk of mortality compared to low-flux dialysis (hazard ratio 0.42; P=0.105), but without a statistical significance.
  
  
  CONCLUSIONS
  This study has demonstrated two-year survival benefit with high-flux hemodialysis and hemodiafiltration compared with low-flux hemodialysis. There was no difference in survival between high-flux hemodialysis and hemodiafiltration groups.
authors.forename: Petar S
authors.initials: PS
authors.lastname: Đurić
authors.forename: Jovan
authors.initials: J
authors.lastname: Popović
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Janković
authors.forename: Jelena
authors.initials: J
authors.lastname: Tošić
authors.forename: Nada
authors.initials: N
authors.lastname: Dimković
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000188:drug therapy; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D004921:Erythropoietin