title: Hemodiafiltration Versus Hemodialysis and Survival in Patients With ESRD: The French Renal Epidemiology and Information Network (REIN) Registry.
abstract: BACKGROUND
  Recent randomized trials report that mortality is lower with high-convection-volume hemodiafiltration (HDF) than with hemodialysis (HD).
  
  
  METHODS
  We used data from the French national Renal Epidemiology and Information Network (REIN) registry to investigate trends in HDF use and its relationship with mortality in the total population of incident dialysis patients.
  
  
  METHODS
  The study included those who initiated HD therapy from January 1, 2008, through December 31, 2011, and were dialyzed for more than 3 months; follow-up extended to the end of 2012.
  
  
  METHODS
  HDF use at the patient and facility level.
  
  
  RESULTS
  All-cause and cardiovascular mortality, using Cox models to estimate HRs of HDF as time-dependent covariate at the patient level, with age as time scale and fully adjusted for comorbid conditions and laboratory data at baseline, catheter use, and facility type as time-dependent covariates. Analyses completed by Cox models for HRs of the facility-level exposure to HDF updated yearly.
  
  
  RESULTS
  Of 28,407 HD patients, 5,526 used HDF for a median of 1.2 (IQR, 0.9-1.9) years; 2,254 of them used HDF exclusively. HRs for all-cause and cardiovascular mortality associated with HDF use were 0.84 (95% CI, 0.77-0.91) and 0.73 (95% CI, 0.61-0.88), respectively. In patients treated exclusively with HDF, these HRs were 0.77 (95% CI, 0.67-0.87) and 0.66 (95% CI, 0.50-0.86). At the facility level, increasing the percentage of patients using HDF from 0% to 100% was associated with HRs for all-cause and cardiovascular mortality of 0.87 (95% CI, 0.77-0.99) and 0.72 (95% CI, 0.54-0.96), respectively.
  
  
  CONCLUSIONS
  Observational study.
  
  
  CONCLUSIONS
  Whether analyzed as a patient- or facility-level predictor, HDF treatment was associated with better survival.
authors.affiliation: Department of Nephrology, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Paris, France; INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France; Paris Sud University, Kremlin-Bicêtre, France; Versailles Saint-Quentin University, Versailles, France. Electronic address: lucile.mercadal@aphp.fr.
authors.forename: Lucile
authors.initials: L
authors.lastname: Mercadal
authors.affiliation: INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France.
authors.forename: Jeanna-Eve
authors.initials: JE
authors.lastname: Franck
authors.affiliation: INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France; Paris Sud University, Kremlin-Bicêtre, France; Versailles Saint-Quentin University, Versailles, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Clinique du Landy, Saint Ouen, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Urena Torres
authors.affiliation: Nephrology Department, Narbonne Polyclinic, Narbonne, France.
authors.forename: François
authors.initials: F
authors.lastname: de Cornelissen
authors.affiliation: Nephrology Department, Dieppe Hospital, Dieppe, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Edet
authors.affiliation: Nephrology Department, Caen Hospital, Caen, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Béchade
authors.affiliation: Nephrology Department, Pontchaillou Rennes University Hospital, Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.affiliation: INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France; Paris Sud University, Kremlin-Bicêtre, France; Versailles Saint-Quentin University, Versailles, France.
authors.forename: Tilman
authors.initials: T
authors.lastname: Drüeke
authors.affiliation: INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France; Paris Sud University, Kremlin-Bicêtre, France; Versailles Saint-Quentin University, Versailles, France; Biomedicine Agency, La Plaine Saint-Denis, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.affiliation: INSERM UMRS-1018, CESP Team 5 (Renal and Cardiovascular Epidemiology), Villejuif, France; Paris Sud University, Kremlin-Bicêtre, France; Versailles Saint-Quentin University, Versailles, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D017583:Hemodiafiltration; D006801:Humans; D007255:Information Services; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis; D015996:Survival Rate
keywords: Hemodialysis (HD); cardiovascular mortality; dialysis; end-stage renal disease (ESRD); epidemiology; hemodiafiltration (HDF); mortality; registry-based study; survival; treatment modality