TY - JOUR
T1 - Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients
T2 - the effect of adjustment for body size
AU - Davenport, Andrew
AU - Peters, Sanne A E
AU - Bots, Michiel L.
AU - Canaud, Bernard
AU - Grooteman, Muriel P C
AU - Asci, Gulay
AU - Locatelli, Francesco
AU - Maduell, Francisco
AU - Morena, Marion
AU - Nubé, Menso J.
AU - Ok, Ercan
AU - Torres, Ferran
AU - Woodward, Mark
AU - Blankestijn, Peter J.
PY - 2016
Y1 - 2016
N2 - Mortality remains high for hemodialysis patients. Online hemodiafiltration (OL-HDF) removes more middle-sized uremic toxins but outcomes of individual trials comparing OL-HDF with hemodialysis have been discrepant. Secondary analyses reported higher convective volumes, easier to achieve in larger patients, improved survival. Here we tested different methods to standardize OL-HDF convection volume on all-cause and cardiovascular mortality compared with hemodialysis. Pooled individual patient analysis of four prospective trials compared thirds of delivered convection volume with hemodialysis. Convection volumes were either not standardized or standardized to weight, body mass index, body surface area, and total body water. Data were analyzed by multivariable Cox proportional hazards modeling from 2793 patients. All-cause mortality was reduced when the convective dose was unstandardized or standardized to body surface area and total body water; hazard ratio (95% confidence intervals) of 0.65 (0.51–0.82), 0.74 (0.58–0.93), and 0.71 (0.56–0.93) for those receiving higher convective doses. Standardization by body weight or body mass index gave no significant survival advantage. Higher convection volumes were generally associated with greater survival benefit with OL-HDF, but results varied across different ways of standardization for body size. Thus, further studies should take body size into account when evaluating the impact of delivered convection volume on mortality end points.Kidney International advance online publication, 9 September 2015; doi:10.1038/ki.2015.264.
AB - Mortality remains high for hemodialysis patients. Online hemodiafiltration (OL-HDF) removes more middle-sized uremic toxins but outcomes of individual trials comparing OL-HDF with hemodialysis have been discrepant. Secondary analyses reported higher convective volumes, easier to achieve in larger patients, improved survival. Here we tested different methods to standardize OL-HDF convection volume on all-cause and cardiovascular mortality compared with hemodialysis. Pooled individual patient analysis of four prospective trials compared thirds of delivered convection volume with hemodialysis. Convection volumes were either not standardized or standardized to weight, body mass index, body surface area, and total body water. Data were analyzed by multivariable Cox proportional hazards modeling from 2793 patients. All-cause mortality was reduced when the convective dose was unstandardized or standardized to body surface area and total body water; hazard ratio (95% confidence intervals) of 0.65 (0.51–0.82), 0.74 (0.58–0.93), and 0.71 (0.56–0.93) for those receiving higher convective doses. Standardization by body weight or body mass index gave no significant survival advantage. Higher convection volumes were generally associated with greater survival benefit with OL-HDF, but results varied across different ways of standardization for body size. Thus, further studies should take body size into account when evaluating the impact of delivered convection volume on mortality end points.Kidney International advance online publication, 9 September 2015; doi:10.1038/ki.2015.264.
UR - http://www.scopus.com/inward/record.url?scp=84941243390&partnerID=8YFLogxK
U2 - 10.1038/ki.2015.264
DO - 10.1038/ki.2015.264
M3 - Article
C2 - 26352299
AN - SCOPUS:84941243390
SN - 0085-2538
VL - 89
SP - 193
EP - 199
JO - Kidney International
JF - Kidney International
IS - 1
ER -