TY - JOUR
T1 - Long-Term Peridialytic Blood Pressure Patterns in Patients Treated by Hemodialysis and Hemodiafiltration
AU - Rootjes, Paul A.
AU - de Roij van Zuijdewijn, Camiel L.M.
AU - Grooteman, Muriel P.C.
AU - Bots, Michiel L.
AU - Canaud, Bernard
AU - Blankestijn, Peter J.
AU - van Ittersum, Frans J.
AU - Maduell, Francisco
AU - Morena, Marion
AU - Peters, Sanne A.E.
AU - Davenport, Andrew
AU - Vernooij, Robin W.M.
AU - Nubé, Menso J.
AU - Torres, Ferran
AU - Ok, Ercan
AU - Asci, Gulay
AU - Locatelli, Francesco
N1 - Funding Information:
PAR, MPCG, and MJN report grant support from Niercentrum aan de Amstel, Elyse Klinieken, and B. Braun Avitum AG. MPCG and MJN report receiving grant support from the Dutch Kidney Foundation, Fresenius Medical Care Netherlands BV, Gambro Sweden, Twiss Fund, and ZonMw during the conduct of the study. BC reports being a part-time employee of Fresenius Medical Care acting as scientific consultant. PJB reports grant support from Fresenius Medical Care, ZonMw, Baxter, Gambro, and the Dutch Kidney Foundation during the conduct of the study. FJvI reports grant support from Elyse Klinieken and B. Braun Avitum AG. He received personal fees from Shire. FM reports receiving personal fees from Baxter, Fresenius Medical Care, Medtronic, and Nipro, all outside this submitted work. SAEP reports grant support by receiving a UK Medical Research Council Skills Development Fellowship grant. AD reports grant support by receiving a UK NIHR grant. All the other authors declared no competing interests.
Funding Information:
For this particular study there was no funding nor grant support. However, this study used the individual participant data (IPD) from 3 randomized controlled trials: the Convective Transport Study (CONTRAST), the French Convective versus Hemodialysis in Elderly (FRENCHIE) study, and the On-Line Haemodiafiltration Survival Study (ESHOL). These studies did receive support as follows. CONTRAST was supported by a grant from the Dutch Kidney Foundation (Nierstichting Nederland Grant C02.2019) and unrestricted grants from Fresenius Medical Care, Netherlands, and Gambro Lundia AB, Sweden. Additional support was received from the Dr. E.E. Twiss Fund, Roche Netherlands, the International Society of Nephrology/Baxter Extramural Grant Program, and the Netherlands Organization for Health Research and Development (ZONMw Grant 170882802). The FRENCHIE study was supported by a grant from the French Ministry of Health (Programme Hospitaller de Recherche Clinique PHRC national chez les sujets âgés-UF 7753). ESHOL was partly supported by grants from Fresenius Medical Care and Gambro through the Catalan Society of Nephrology.
Funding Information:
For this particular study there was no funding nor grant support. However, this study used the individual participant data (IPD) from 3 randomized controlled trials: the Convective Transport Study (CONTRAST), the French Convective versus Hemodialysis in Elderly (FRENCHIE) study, and the On-Line Haemodiafiltration Survival Study (ESHOL). These studies did receive support as follows. CONTRAST was supported by a grant from the Dutch Kidney Foundation (Nierstichting Nederland Grant C02.2019) and unrestricted grants from Fresenius Medical Care, Netherlands, and Gambro Lundia AB, Sweden. Additional support was received from the Dr. E.E. Twiss Fund, Roche Netherlands, the International Society of Nephrology/Baxter Extramural Grant Program, and the Netherlands Organization for Health Research and Development (ZONMw Grant 170882802). The FRENCHIE study was supported by a grant from the French Ministry of Health (Programme Hospitaller de Recherche Clinique PHRC national chez les sujets âgés-UF 7753). ESHOL was partly supported by grants from Fresenius Medical Care and Gambro through the Catalan Society of Nephrology.
Publisher Copyright:
© 2020 International Society of Nephrology
PY - 2020/4
Y1 - 2020/4
N2 - Introduction: Online postdilution hemodiafiltration (HDF) is associated with a lower all-cause and cardiovascular mortality than hemodialysis (HD). This may depend on a superior peridialytic (pre- and postdialysis, and the difference between these 2 parameters) hemodynamic profile.Methods: In this retrospective cohort analysis of individual participant data (IPD) from 3 randomized controlled trials (RCTs) (n = 2011), the effect of HDF and HD on 2-year peridialytic blood pressure (BP) patterns was assessed. Long-term peridialytic systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), as well as the deltas (post- minus predialytic) were assessed in the total group of patients. Thereafter, these variables were compared between patients on HD and HDF, and in the latter group between quartiles of convection volume.Results: Mean pre- and postdialysis SBP, DBP, and MAP declined significantly during follow-up (predialytic: SBP -2.16 mm Hg, DBP -2.88 mm Hg, MAP -2.64 mm Hg), PP increased (predialytic 0.96 mm Hg). Peridialytic deltas remained unaltered. Differences between the 2 modalities, or between quartiles of convection volume were not observed. BP changes were independent of various baseline characteristics, including the decline in body weight over time.Conclusion: We speculate that the combination of a decreasing SBP and an increasing PP may be the clinical sequelae of a worsening cardiovascular system. Because especially HDF with a high convection volume has been associated with a beneficial effect on survival, our study does not support the view that superior peridialytic BP control contributes to this effect.
AB - Introduction: Online postdilution hemodiafiltration (HDF) is associated with a lower all-cause and cardiovascular mortality than hemodialysis (HD). This may depend on a superior peridialytic (pre- and postdialysis, and the difference between these 2 parameters) hemodynamic profile.Methods: In this retrospective cohort analysis of individual participant data (IPD) from 3 randomized controlled trials (RCTs) (n = 2011), the effect of HDF and HD on 2-year peridialytic blood pressure (BP) patterns was assessed. Long-term peridialytic systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), as well as the deltas (post- minus predialytic) were assessed in the total group of patients. Thereafter, these variables were compared between patients on HD and HDF, and in the latter group between quartiles of convection volume.Results: Mean pre- and postdialysis SBP, DBP, and MAP declined significantly during follow-up (predialytic: SBP -2.16 mm Hg, DBP -2.88 mm Hg, MAP -2.64 mm Hg), PP increased (predialytic 0.96 mm Hg). Peridialytic deltas remained unaltered. Differences between the 2 modalities, or between quartiles of convection volume were not observed. BP changes were independent of various baseline characteristics, including the decline in body weight over time.Conclusion: We speculate that the combination of a decreasing SBP and an increasing PP may be the clinical sequelae of a worsening cardiovascular system. Because especially HDF with a high convection volume has been associated with a beneficial effect on survival, our study does not support the view that superior peridialytic BP control contributes to this effect.
KW - blood pressure
KW - hemodiafiltration
KW - hemodialysis
KW - individual participant data
KW - peridialytic
UR - http://www.scopus.com/inward/record.url?scp=85081251433&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2020.01.007
DO - 10.1016/j.ekir.2020.01.007
M3 - Article
C2 - 32274454
AN - SCOPUS:85081251433
SN - 2468-0249
VL - 5
SP - 503
EP - 510
JO - Kidney International Reports
JF - Kidney International Reports
IS - 4
ER -