Technique that removes additional toxins prolongs dialysis patients' lives

Hemodiafiltration reduces risk of dying over the course of a 3-year study

2013-02-15

(Press-News.org) Highlights A technique that removes additional toxins during dialysis decreased kidney failure patients' risk of dying from any cause by 30% over three years. The technique also reduced patients' risk of dying from heart-related causes or infections.

15% to 25% of dialysis patients die annually.

Washington, DC (February 14, 2013) — A technique that removes additional toxins during dialysis may prolong kidney failure patients' lives, according to a clinical trial appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). In light of these results, the technique may become standard for dialysis patients.

Retrospective studies suggest that on-line hemodiafiltration (OL-HDF)—which is different from standard dialysis in that it uses so-called high convective transport to remove additional substances over a wide range of sizes—may reduce kidney failure patients' risk of dying prematurely compared with standard hemodialysis. However, results from prospective studies have contradicted this finding.

To investigate the issue further, Francisco Maduell, MD, PhD (Hospital Clinic, in Barcelona, Spain) and his colleagues conducted a multicenter, open-label, randomized controlled trial in which they assigned 906 dialysis patients either to continue hemodialysis or to switch to OL-HDF, with higher convective volume than in previous prospective trials. Patients were followed for three years.

Among the major findings over the course of the three-year study: Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of dying from any cause, a 33% lower risk of dying from cardiovascular-related causes, and a 55% lower risk of dying from an infection. The study's findings suggest that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. Hospitalizations and dialysis sessions complicated by low blood pressure were lower in patients assigned to OL-HDF.

The findings indicate that OL-HDF may indeed prolong kidney failure patients' lives compared with conventional hemodialysis. "Mortality remains very high in dialysis patients, ranging from 15% to 25% annually. Any reduction of this mortality would be an important achievement," said Dr. Maduell. "In view of this study's results, OL-HDF may become the first-line option in hemodialysis patients," he added.

### Study co-authors include Francesc Moreso, MD, PhD, Mercedes Pons, MD, Rosa Ramos, MD, PhD, Josep Mora-Macia, MD, PhD, Jordi Carreras, MD, Jordi Soler, MD, Ferran Torres, MD, PhD, Josep Campistol, MD, PhD, and Alberto Martinez-Castelao, MD, PhD, for the ESHOL Study Group.

Disclosures: This study was partly supported by grants from Fresenius Medical Care and Gambro through the Catalonian Society of Nephrology. The authors reported no financial disclosures related with the study.

The article, entitled "High-Efficiency Postdilution On-Line Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients," will appear online at http://jasn.asnjournals.org/ on February 14, 2013, doi: 10.1681/ASN.2012080875.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

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.

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Technique that removes additional toxins prolongs dialysis patients' lives

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