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Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis.

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PubMed
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Post-dilution online-haemodiafiltration (ol-HDF) significantly reduces all-cause and cardiovascular disease (CVD) mortality compared to haemodialysis (HD). The benefit is primarily driven by a decrease in fatal cardiac events, including ischemic heart disease and congestion.

Keywords:
cardiovascular diseaseconvection volumehaemodiafiltrationmeta-analysismortality

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Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Epidemiology

Background:

  • Previous meta-analyses indicated haemodialysis (HD) and post-dilution online-haemodiafiltration (ol-HDF) impact on mortality.
  • Uncertainty remained regarding whether reduced mortality with ol-HDF was solely due to cardiovascular disease (CVD) event reduction and specific CVD types prevented.

Purpose of the Study:

  • To investigate the specific causes of mortality reduced by ol-HDF compared to HD.
  • To determine the contribution of different cardiovascular disease (CVD) subtypes to the overall mortality benefit of ol-HDF.

Main Methods:

  • Utilized an individual participant data (IPD) meta-analysis from four randomized controlled trials.
  • Employed Cox proportional hazard regression models to calculate hazard ratios and confidence intervals for cause-specific mortality.
  • Calculated annualized mortality rates and numbers needed to treat (NNT).

Main Results:

  • ol-HDF showed a significant reduction in cardiac mortality (HR 0.64 [0.61; 0.90]), including ischemic heart disease and congestion.
  • No significant differences in mortality risk were observed for 'other causes' like malignancies or withdrawal from treatment between HD and ol-HDF.
  • High-volume ol-HDF (HV-HDF) requires treating 75 patients per year to prevent one CVD death.

Conclusions:

  • The mortality benefit of ol-HDF over HD is primarily attributed to a reduction in fatal cardiac events.
  • ol-HDF demonstrates a significant protective effect against cardiac casualties, encompassing ischemic heart disease and congestion.
  • The NNT for HV-HDF to prevent one CVD death annually is 75.