Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study

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dc.contributor.authorOk, Ercan
dc.contributor.authorAsci, Gulay
dc.contributor.authorToz, Huseyin
dc.contributor.authorOk, Ebru Sevinc
dc.contributor.authorKircelli, Fatih
dc.contributor.authorYilmaz, Mumtaz
dc.contributor.authorHur, Ender
dc.date.accessioned2024-04-24T17:08:07Z
dc.date.available2024-04-24T17:08:07Z
dc.date.issued2013
dc.departmentDicle Üniversitesien_US
dc.description.abstractBackground. Online haemodiafiltration (OL-HDF) is considered to confer clinical benefits over haemodialysis (HD) in terms of solute removal in patients undergoing maintenance HD. The aim of this study was to compare postdilution OL-HDF and high-flux HD in terms of morbidity and mortality. Methods. In this prospective, randomized, controlled trial, we enrolled 782 patients undergoing thrice-weekly HD and randomly assigned them in a 1:1 ratio to either postdilution OL-HDF or high-flux HD. The mean age of patients was 56.5 +/- 13.9 years, time on HD 57.9 +/- 44.6 months with a diabetes incidence of 34.7%. The follow-up period was 2 years, with the mean follow-up of 22.7 +/- 10.9 months. The primary outcome was a composite of death from any cause and nonfatal cardiovascular events. The major secondary outcomes were cardiovascular and overall mortality, intradialytic complications, hospitalization rate, changes in several laboratory parameters and medications used. Results. The filtration volume in OL-HDF was 17.2 +/- 1.3 L. Primary outcome was not different between the groups (event-free survival of 77.6% in OL-HDF versus 74.8% in the high-flux group, P = 0.28), as well as cardiovascular and overall survival, hospitalization rate and number of hypotensive episodes. In a post hoc analysis, the subgroup of OL-HDF patients treated with a median substitution volume >17.4 L per session (high-efficiency OL-HDF, n = 195) had better cardiovascular (P = 0.002) and overall survival (P = 0.03) compared with the high-flux BD group. In adjusted Cox-regression analysis, treatment with high-efficiency OL-BDF was associated with a 46% risk reduction for overall mortality {RR = 0.54 [95% confidence interval (95% CI) 0.31-0.93], P = 0.02} and a 71% risk reduction for cardiovascular mortality [RR = 0.29 (95% CI 0.12-0.65), P = 0.003] compared with high-flux BD. Conclusions. The composite of all-cause mortality and nonfatal cardiovascular event rate was not different in the OL-HDF and in the high-flux BD groups. In a post hoc analysis, OL-HDF treatment with substitution volumes over 17.4 L was associated with better cardiovascular and overall survival.en_US
dc.description.sponsorshipEuropean Nephrology and Dialysis Instituteen_US
dc.description.sponsorshipThe study was supported by European Nephrology and Dialysis Institute with an unrestricted grant. The study was performed in Fresenius Medical Care haemodialysis clinics in Turkey. Neither the sponsor nor Fresenius Medical Care had a role in study design and conduction, data management, collection and analysis, preparation and submission of the manuscript.en_US
dc.identifier.doi10.1093/ndt/gfs407
dc.identifier.endpage202en_US
dc.identifier.issn0931-0509
dc.identifier.issue1en_US
dc.identifier.pmid23229932en_US
dc.identifier.scopus2-s2.0-84872248257en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage192en_US
dc.identifier.urihttps://doi.org/10.1093/ndt/gfs407
dc.identifier.urihttps://hdl.handle.net/11468/17212
dc.identifier.volume28en_US
dc.identifier.wosWOS:000315540100033
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoenen_US
dc.publisherOxford Univ Pressen_US
dc.relation.ispartofNephrology Dialysis Transplantationen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectHigh-Flux Haemodialysisen_US
dc.subjectOnline Haemodiafiltrationen_US
dc.subjectOutcomeen_US
dc.titleMortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Studyen_US
dc.typeArticleen_US

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