A technique that removes additional toxins during dialysis does not improve kidney failure patients’ survival or heart health, but intense treatments may provide a benefit, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings suggest that the potential of the technique, called hemodiafiltration, deserves more study.
Kidney failure patients on dialysis have a high risk of developing heart problems and dying from heart disease. Retention of certain toxins may play a role because during conventional hemodialysis, smaller substances are removed while larger toxins can accumulate in the body. A technique called hemodiafiltration, which allows for accelerated blood flow during dialysis, may help get rid of some of these toxins.
Peter Blankestijn, MD, PhD (University Medical Center Utrecht, in the Netherlands) and his colleagues looked to see if hemodiafiltration improves patients’ survival and heart health compared with standard hemodialysis. Of 714 dialysis patients in the study, 358 received hemodiafiltration and 356 continued hemodialysis. “This is the largest randomized clinical trial comparing standard hemodialysis versus hemodiafiltration on meaningful clinical endpoints,” said Dr. Blankestijn.
After following patients for an average of three years, the researchers found no difference between the two groups in terms of patient survival or rates of non-fatal heart problems; however, not all patients in the hemodiafiltration group received the proper dose of treatment. Patients who received the highest dose of hemodiafiltration were indeed less likely to die than those receiving hemodialysis. Additional studies are needed to confirm these findings.
Study co-authors include Muriel Grooteman, MD, PhD, E. Lars Penne, MD, PhD, Neelke van der Weerd, MD, Menso Nubé, MD, PhD, Piet M. ter Wee, MD, PhD (VU University Medical Center, in Amsterdam, the Netherlands); Marinus van den Dorpel, MD, PhD, Claire den Hoedt, MD (Maasstad Hospital, in Rotterdam, the Netherlands); Michiel Bots, MD, PhD, Ingeborg van der Tweel, PhD, Albert Mazairac, MD (University Medical Center Utrecht, in the Netherlands); Renée Lévesque, MD (St-Luc Hospital, in Montréal, Canada); for the CONTRAST investigators.
• A technique that removes additional toxins during dialysis does not improve kidney failure patients’ survival or heart health, but intense treatments may provide a benefit.
• The technique, called hemodiafiltration, deserves more study.
Kidney failure is on the rise and currently afflicts 2 million people worldwide.
Disclosures: This work 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 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 article, entitled “Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes,” will appear online at http://jasn.asnjournals.org/ on April 26, 2012, doi: 10.1681/ASN.2011121140.
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Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
Source: American Society of Nephrology (ASN)