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Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials.

Identifieur interne : 001D28 ( PubMed/Checkpoint ); précédent : 001D27; suivant : 001D29

Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials.

Auteurs : Sanne A E. Peters [Pays-Bas] ; Michiel L. Bots [Pays-Bas] ; Bernard Canaud [France] ; Andrew Davenport [Royaume-Uni] ; Muriel P C. Grooteman [Pays-Bas] ; Fatih Kircelli [Turquie] ; Francesco Locatelli [Italie] ; Francisco Maduell [Espagne] ; Marion Morena [France] ; Menso J. Nubé [Pays-Bas] ; Ercan Ok [Turquie] ; Ferran Torres [Espagne] ; Mark Woodward [États-Unis] ; Peter J. Blankestijn [Pays-Bas]

Source :

RBID : pubmed:26492924

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English descriptors

Abstract

Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials (RCTs) comparing HDF with conventional HD on all-cause and cause-specific mortality in end-stage kidney disease (ESKD) patients reported inconsistent results and were at high risk of bias. We conducted a pooled individual participant data analysis of RCTs to provide the most reliable evidence to date on the effects of HDF on mortality outcomes in ESKD patients.

DOI: 10.1093/ndt/gfv349
PubMed: 26492924


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pubmed:26492924

Le document en format XML

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<placeName>
<region type="state">Maryland</region>
<settlement type="city">Oxford</settlement>
</placeName>
<orgName type="university">Université d'Oxford</orgName>
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<name sortKey="Blankestijn, Peter J" sort="Blankestijn, Peter J" uniqKey="Blankestijn P" first="Peter J" last="Blankestijn">Peter J. Blankestijn</name>
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<nlm:affiliation>Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation>
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<title level="j">Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association</title>
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<term>Aged</term>
<term>Cause of Death (trends)</term>
<term>Europe (epidemiology)</term>
<term>Female</term>
<term>Hemodiafiltration (methods)</term>
<term>Humans</term>
<term>Kidney Failure, Chronic (mortality)</term>
<term>Kidney Failure, Chronic (therapy)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Proportional Hazards Models</term>
<term>Renal Dialysis (methods)</term>
<term>Risk Factors</term>
<term>Survival Rate (trends)</term>
</keywords>
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<term>Adulte d'âge moyen</term>
<term>Cause de décès (tendances)</term>
<term>Dialyse rénale ()</term>
<term>Défaillance rénale chronique ()</term>
<term>Défaillance rénale chronique (mortalité)</term>
<term>Europe (épidémiologie)</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Hémodiafiltration ()</term>
<term>Modèles de hasards proportionnels</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Taux de survie (tendances)</term>
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<term>Europe</term>
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<term>Hemodiafiltration</term>
<term>Renal Dialysis</term>
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</keywords>
<keywords scheme="MESH" qualifier="mortalité" xml:lang="fr">
<term>Défaillance rénale chronique</term>
</keywords>
<keywords scheme="MESH" qualifier="tendances" xml:lang="fr">
<term>Cause de décès</term>
<term>Taux de survie</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en">
<term>Kidney Failure, Chronic</term>
</keywords>
<keywords scheme="MESH" qualifier="trends" xml:lang="en">
<term>Cause of Death</term>
<term>Survival Rate</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr">
<term>Europe</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Aged</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Proportional Hazards Models</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Dialyse rénale</term>
<term>Défaillance rénale chronique</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Hémodiafiltration</term>
<term>Modèles de hasards proportionnels</term>
<term>Mâle</term>
<term>Sujet âgé</term>
</keywords>
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<front>
<div type="abstract" xml:lang="en">Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials (RCTs) comparing HDF with conventional HD on all-cause and cause-specific mortality in end-stage kidney disease (ESKD) patients reported inconsistent results and were at high risk of bias. We conducted a pooled individual participant data analysis of RCTs to provide the most reliable evidence to date on the effects of HDF on mortality outcomes in ESKD patients.</div>
</front>
</TEI>
<pubmed>
<MedlineCitation Status="MEDLINE" Owner="NLM">
<PMID Version="1">26492924</PMID>
<DateCreated>
<Year>2016</Year>
<Month>05</Month>
<Day>24</Day>
</DateCreated>
<DateCompleted>
<Year>2017</Year>
<Month>09</Month>
<Day>13</Day>
</DateCompleted>
<DateRevised>
<Year>2017</Year>
<Month>09</Month>
<Day>13</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">1460-2385</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>31</Volume>
<Issue>6</Issue>
<PubDate>
<Year>2016</Year>
<Month>Jun</Month>
</PubDate>
</JournalIssue>
<Title>Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association</Title>
<ISOAbbreviation>Nephrol. Dial. Transplant.</ISOAbbreviation>
</Journal>
<ArticleTitle>Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials.</ArticleTitle>
<Pagination>
<MedlinePgn>978-84</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1093/ndt/gfv349</ELocationID>
<Abstract>
<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials (RCTs) comparing HDF with conventional HD on all-cause and cause-specific mortality in end-stage kidney disease (ESKD) patients reported inconsistent results and were at high risk of bias. We conducted a pooled individual participant data analysis of RCTs to provide the most reliable evidence to date on the effects of HDF on mortality outcomes in ESKD patients.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">Individual participant data were used from four trials that compared online HDF with HD and were designed to examine the effects of HDF on mortality endpoints. Bias by informative censoring of patients was resolved. Hazard ratios (HRs) and 95% confidence intervals (95% CI) comparing the effect of online HDF versus HD on all-cause and cause-specific mortality were calculated using the Cox proportional hazard regression models. The relationship between convection volume and the study outcomes was examined by delivered convection volume standardized to body surface area.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">After a median follow-up of 2.5 years (Q1-Q3: 1.9-3.0), 769 of the 2793 participants had died (292 cardiovascular deaths). Online HDF reduced the risk of all-cause mortality by 14% (95% CI: 1%; 25%) and cardiovascular mortality by 23% (95% CI: 3%; 39%). There was no evidence for a differential effect in subgroups. The largest survival benefit was for patients receiving the highest delivered convection volume [>23 L per 1.73 m(2) body surface area (BSA) per session], with a multivariable-adjusted HR of 0.78 (95% CI: 0.62; 0.98) for all-cause mortality and 0.69 (95% CI: 0.47; 1.00) for cardiovascular disease mortality.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">This pooled individual participant analysis on the effects of online HDF compared with conventional HD indicates that online HDF reduces the risk of mortality in ESKD patients. This effect holds across a variety of important clinical subgroups of patients and is most pronounced for those receiving a higher convection volume normalized to BSA.</AbstractText>
<CopyrightInformation>© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</CopyrightInformation>
</Abstract>
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<Author ValidYN="Y">
<LastName>Peters</LastName>
<ForeName>Sanne A E</ForeName>
<Initials>SA</Initials>
<AffiliationInfo>
<Affiliation>The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Bots</LastName>
<ForeName>Michiel L</ForeName>
<Initials>ML</Initials>
<AffiliationInfo>
<Affiliation>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Canaud</LastName>
<ForeName>Bernard</ForeName>
<Initials>B</Initials>
<AffiliationInfo>
<Affiliation>Nephrology, Dialysis and Intensive Care Unit, CHRU, Montpellier, France Dialysis Research and Training Institute, Montpellier, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Davenport</LastName>
<ForeName>Andrew</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>University College London, Centre for Nephrology, Royal Free Hospital, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Grooteman</LastName>
<ForeName>Muriel P C</ForeName>
<Initials>MP</Initials>
<AffiliationInfo>
<Affiliation>Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Kircelli</LastName>
<ForeName>Fatih</ForeName>
<Initials>F</Initials>
<AffiliationInfo>
<Affiliation>Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Locatelli</LastName>
<ForeName>Francesco</ForeName>
<Initials>F</Initials>
<AffiliationInfo>
<Affiliation>Department of Nephrology, Alessandro Manzoni Hospital, Lecco, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Maduell</LastName>
<ForeName>Francisco</ForeName>
<Initials>F</Initials>
<AffiliationInfo>
<Affiliation>Nephrology Department, Hospital Clinic, Barcelona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Morena</LastName>
<ForeName>Marion</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Dialysis Research and Training Institute, Montpellier, France Biochemistry Laboratory, CHRU, Montpellier, France U1046 INSERM, University of Montpellier I, Montpellier, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Nubé</LastName>
<ForeName>Menso J</ForeName>
<Initials>MJ</Initials>
<AffiliationInfo>
<Affiliation>Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Ok</LastName>
<ForeName>Ercan</ForeName>
<Initials>E</Initials>
<AffiliationInfo>
<Affiliation>Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Torres</LastName>
<ForeName>Ferran</ForeName>
<Initials>F</Initials>
<AffiliationInfo>
<Affiliation>Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Woodward</LastName>
<ForeName>Mark</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Blankestijn</LastName>
<ForeName>Peter J</ForeName>
<Initials>PJ</Initials>
<AffiliationInfo>
<Affiliation>Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<CollectiveName>HDF Pooling Project Investigators</CollectiveName>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList>
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<PublicationType UI="D016448">Multicenter Study</PublicationType>
<PublicationType UI="D016449">Randomized Controlled Trial</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic">
<Year>2015</Year>
<Month>10</Month>
<Day>22</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo>
<Country>England</Country>
<MedlineTA>Nephrol Dial Transplant</MedlineTA>
<NlmUniqueID>8706402</NlmUniqueID>
<ISSNLinking>0931-0509</ISSNLinking>
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<CitationSubset>IM</CitationSubset>
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<DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D002423" MajorTopicYN="N">Cause of Death</DescriptorName>
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<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
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<MeshHeading>
<DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D017583" MajorTopicYN="N">Hemodiafiltration</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName>
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<MeshHeading>
<DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D007676" MajorTopicYN="N">Kidney Failure, Chronic</DescriptorName>
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<DescriptorName UI="D016016" MajorTopicYN="N">Proportional Hazards Models</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D006435" MajorTopicYN="N">Renal Dialysis</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName>
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<MeshHeading>
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<QualifierName UI="Q000639" MajorTopicYN="N">trends</QualifierName>
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</MeshHeadingList>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="N">ESKD</Keyword>
<Keyword MajorTopicYN="N">clinical trial</Keyword>
<Keyword MajorTopicYN="N">epidemiology</Keyword>
<Keyword MajorTopicYN="N">haemodiafiltration</Keyword>
<Keyword MajorTopicYN="N">haemodialysis</Keyword>
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<Month>03</Month>
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<Year>2015</Year>
<Month>08</Month>
<Day>28</Day>
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<li>Royaume-Uni</li>
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