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Published on: October 2, 2020
A randomized trial of hemodiafiltration and change in cardiovascular parameters
Irina M Mostovaya1, Michiel L Bots, Marinus A van den Dorpel
1Department of Nephrology and, †Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands;, ‡Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands;, §Department of Nephrology,, ‖Institute for Cardiovascular Research, and, ¶Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands, *Department of Nephrology, Centre Hospitalier de l'Université de Montréal, St. Luc Hospital, Montréal, Québec, Canada.
Insights
Online hemodiafiltration (HDF) did not significantly alter left ventricular mass (LVM), ejection fraction (EF), or pulse-wave velocity (PWV) compared to low-flux hemodialysis (HD) in ESRD patients. This study found no difference in cardiovascular outcomes between the two dialysis methods.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Medical Technology
Background:
- Increased left ventricular mass (LVM), low ejection fraction (EF), and high pulse-wave velocity (PWV) are linked to mortality in end-stage renal disease (ESRD).
- Online hemodiafiltration (HDF) is a dialysis modality that may offer cardiovascular benefits over conventional hemodialysis (HD).
Purpose of the Study:
- To compare the effects of online HDF versus low-flux HD on LVM, EF, and PWV in ESRD patients.
- To assess whether HDF influences key cardiovascular parameters more favorably than HD.
Main Methods:
- A prospective study involving 342 ESRD patients (CONvective TRAnsport STudy).
- Echocardiography used to measure LVM and EF over up to 4 years.
- PWV measured in 189 patients over up to 3 years; analyzed using linear mixed models.
Main Results:
- No significant differences were observed in the rate of change for LVM, EF, or PWV between the HDF and HD groups.
- Subgroup analyses by age, sex, residual kidney function, and other factors also showed no treatment effect differences.
- Specific changes in LVM, EF, and PWV did not differ statistically between HDF and HD treatments.
Conclusions:
- Online HDF treatment did not demonstrate a significant effect on changes in LVM, EF, or PWV over time when compared to low-flux HD.
- The findings suggest that HDF does not offer a distinct advantage over HD in improving these specific cardiovascular metrics in ESRD patients.
Background And Objective:
Increased left ventricular mass (LVM), low ventricular ejection fraction (EF), and high pulse-wave velocity (PWV) relate to overall and cardiovascular mortality in patients with ESRD. The aim of this study was to determine the effect of online hemodiafiltration (HDF) versus low-flux hemodialysis (HD) on LVM, EF, and PWV.
Design, Setting, Participants, & Measurements:
Echocardiography was used to assess LVM and EF in 342 patients in the CONvective TRAnsport STudy followed for up to 4 years. PWV was measured in 189 patients for up to 3 years. Effect of HDF versus HD on LVM, EF, and PWV was evaluated using linear mixed models.
Results:
Patients had a mean age of 63 years, and 61% were male. At baseline, median LVM was 227 g (interquartile range [IQR], 183-279 g), and median EF was 65% (IQR, 55%-72%). Median PWV was 9.8 m/s (IQR, 7.5-12.0 m/s). There was no significant difference between the HDF and HD treatment groups in rate of change in LVM (HDF: change, -0.9 g/yr [95% confidence interval (95% CI), -8.9 to 7.7 g]; HD: change, 12.5 g/yr [95% CI, -3.0 to 27.5 g]; P for difference=0.13), EF (HDF: change, -0.3%/yr [95% CI, -2.3% to 1.8%]; HD: change, -3.4%/yr [95% CI, -5.9% to -0.9%]; P=0.17), or PWV (HDF: change, -0.0 m/s per year [95% CI, -0.4 to 0.4 m/s); HD: change, 0.0 m/s per year [95% CI, -0.3 to 0.2 m/s]; P=0.89). No differences in rate of change between treatment groups were observed for subgroups of age, sex, residual kidney function, dialysis vintage, history of cardiovascular disease, diabetes, or convection volume.
Conclusions:
Treatment with online HDF did not affect changes in LVM, EF, or PWV over time compared with HD.
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