Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis
Por:
Nube, MJ, Peters, SAE, Blankestijn, PJ, Canaud, B, Davenport, A, Grooteman, MPC, Asci, G, Locatelli, F, Maduell, F, Morena, M, Ok, E, Torres, F, Bots, ML, Coll E., Babinet, François
Publicada:
1 mar 2017
Resumen:
Background. From an individual participant data (IPD) meta-analysis from four randomized controlled trials comparing haemodialysis (HD) with post-dilution online-haemodiafiltration (ol-HDF), previously it appeared that HDF decreases all-cause mortality by 14% (95% confidence interval 25; 1) and fatal cardiovascular disease (CVD) by 23% (39; 3). Significant differences were not found for fatal infections and sudden death. So far, it is unclear, however, whether the reduced mortality risk of HDF is only due to a decrease in CVD events and if so, which CVD in particular is prevented, if compared with HD.
Methods. The IPD base was used for the present study. Hazard ratios and 95% confidence intervals for cause-specific mortality overall and in thirds of the convection volume were calculated using the Cox proportional hazard regression models. Annualized mortality and numbers needed to treat (NNT) were calculated as well.
Results. Besides 554 patients dying from CVD, fatal infections and sudden death, 215 participants died from 'other causes', such as withdrawal from treatment and malignancies. In this group, the mortality risk was comparable between HD and ol-HDF patients, both overall and in thirds of the convection volume. Subdivision of CVD mortality in fatal cardiac, non-cardiac and unclassified CVD showed that ol-HDF was only associated with a lower risk of cardiac casualties [0.64 (0.61; 0.90)]. Annual mortality rates also suggest that the reduction in CVD death is mainly due to a decrease in cardiac fatalities, including both ischaemic heart disease and congestion. Overall, 32 and 75 patients, respectively, need to be treated by high-volume HDF (HV-HDF) to prevent one all-cause and one CVD death, respectively, per year.
Conclusion. The beneficial effect of ol-HDF on all-cause and CVD mortality appears to be mainly due to a reduction in fatal cardiac events, including ischaemic heart disease as well as congestion. In HV-HDF, the NNT to prevent one CVD death is 75 per year.
Filiaciones:
Nube, MJ:
Vrije Univ Amsterdam Med Ctr, Dept Nephrol, Amsterdam, Netherlands
Peters, SAE:
Univ Oxford, George Inst Global Hlth, Oxford, England
Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
Blankestijn, PJ:
Univ Med Ctr Utrecht, Dept Nephrol, Utrecht, Netherlands
Canaud, B:
Ctr Med Excellence, Fresenius Med Care Deutschland, Bad Homburg, Germany
Dialysis Res & Training Inst, Montpellier, France
Davenport, A:
UCL, Royal Free Hosp, Ctr Nephrol, London, England
Grooteman, MPC:
Vrije Univ Amsterdam Med Ctr, Dept Nephrol, Amsterdam, Netherlands
Asci, G:
Ege Univ Sch Med, Div Nephrol, Izmir, Turkey
Locatelli, F:
Alessandro Manzoni Hosp, Dept Nephrol, Lecce, Italy
Maduell, F:
Hosp Clin Barcelona, Dept Nephrol, Barcelona, Spain
Morena, M:
Dialysis Res & Training Inst, Montpellier, France
Univ Montpellier, CNRS UMR 9214, INSERM U1046, CHU,Biochem & Hormonol Dept,PhyMed Exp, Montpellier, France
Ok, E:
Ege Univ Sch Med, Div Nephrol, Izmir, Turkey
Torres, F:
Univ Autonoma Barcelona, Sch Med, Biostat Unit, Barcelona, Spain
Hosp Clin Barcelona, IDIBAPS, Biostat & DataManagement Platform, Barcelona, Spain
Bots, ML:
Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
Coll E.:
Fundacio Puigvert, Barcelona, Spain
Babinet, François :
ECHO Pole Santé Sud Center, Le Mans, France
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