TY - JOUR
T1 - The Effect of Online Hemodiafiltration on Infections
T2 - Results from the CONvective TRAnsport STudy
AU - den Hoedt, Claire H.
AU - Grooteman, Muriel P. C.
AU - Bots, Michiel L.
AU - Blankestijn, Peter J.
AU - van der Tweel, Ingeborg
AU - van der Weerd, Neelke C.
AU - Penne, E. Lars
AU - Mazairac, Albert H. A.
AU - Levesque, Renee
AU - ter Wee, Piet M.
AU - Nube, Menso J.
AU - van den Dorpel, Marinus A.
PY - 2015/8/19
Y1 - 2015/8/19
N2 - BackgroundHemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections.Patients and MethodsWe used data of the 714 HD patients (age 64 +/- 14, 62% men, 25% Diabetes Mellitus, 7% catheters) participating in the CONvective TRAnsport STudy (CONTRAST), a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD. The events were adjudicated by an independent event committee. The risk of infectious events was compared with Cox regression for repeated events and Cox proportional hazard models. The distributions of types of infection were compared between the groups.ResultsThirty one percent of the patients suffered from one or more infections leading to hospitalization during the study (median follow-up 1.96 years). The risk for infections during the entire follow-up did not differ significantly between treatment arms (HDF 198 and HD 169 infections in 800 and 798 person-years respectively, hazard ratio HDF vs. HD 1.09 (0.88-1.34), P = 0.42. No difference was found in the occurrence of the first infectious event (either fatal, non-fatal or type specific). Of all infections, respiratory infections (25% in HDF, 28% in HD) were most common, followed by skin/musculoskeletal infections (21% in HDF, 13% in HD).ConclusionsHDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings.
AB - BackgroundHemodialysis (HD) patients have a high risk of infections. The uremic milieu has a negative impact on several immune responses. Online hemodiafiltration (HDF) may reduce the risk of infections by ameliorating the uremic milieu through enhanced clearance of middle molecules. Since there are few data on infectious outcomes in HDF, we compared the effects of HDF with low-flux HD on the incidence and type of infections.Patients and MethodsWe used data of the 714 HD patients (age 64 +/- 14, 62% men, 25% Diabetes Mellitus, 7% catheters) participating in the CONvective TRAnsport STudy (CONTRAST), a randomized controlled trial evaluating the effect of HDF as compared to low-flux HD. The events were adjudicated by an independent event committee. The risk of infectious events was compared with Cox regression for repeated events and Cox proportional hazard models. The distributions of types of infection were compared between the groups.ResultsThirty one percent of the patients suffered from one or more infections leading to hospitalization during the study (median follow-up 1.96 years). The risk for infections during the entire follow-up did not differ significantly between treatment arms (HDF 198 and HD 169 infections in 800 and 798 person-years respectively, hazard ratio HDF vs. HD 1.09 (0.88-1.34), P = 0.42. No difference was found in the occurrence of the first infectious event (either fatal, non-fatal or type specific). Of all infections, respiratory infections (25% in HDF, 28% in HD) were most common, followed by skin/musculoskeletal infections (21% in HDF, 13% in HD).ConclusionsHDF as compared to HD did not result in a reduced risk of infections, larger studies are needed to confirm our findings.
KW - CHRONIC-HEMODIALYSIS PATIENTS
KW - ALL-CAUSE MORTALITY
KW - RISK-FACTORS
KW - HOSPITALIZATION
KW - MORBIDITY
KW - OUTCOMES
U2 - 10.1371/journal.pone.0135908
DO - 10.1371/journal.pone.0135908
M3 - Article
C2 - 26288091
SN - 1932-6203
VL - 10
JO - PLoS ONE [E]
JF - PLoS ONE [E]
IS - 8
M1 - 0135908
ER -