Hemodiafiltration does not increase the risk for mortality in esrd

Abstract

Rabindranath et al1Rabindranath K.S. Strippoli G.F.M. Roderick P. Wallace S.A. MacLeod A.M. Daly C. Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD Systematic review.Am J Kidney Dis. 2005; 45: 437-447Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar claimed that hemodiafiltration (HDF) was associated with a significantly greater mortality risk than hemodialysis (HD). Their conclusion is not substantiated by any published trial, and the poorer outcome in the HDF group is unexplained. None of the 4 studies comparing HDF with HD (their Fig 2) was adequately powered. All were designed to test efficacy or surrogate outcomes. Follow-up was too short and mortality rates were very low, suggesting that the study patients might not share the typical risk profile of patients with end-stage renal disease. No study showed a significant trend toward poorer survival on HDF therapy. Patients participating in study B of the multicenter trial (Italian Cooperative Dialysis Study Group) were randomized to treatment with cuprophane, low-flux polysulfone, high-flux polysulfone, and high-flux HDF to analyze effects of membranes and dialysis technologies separately.2Locatelli F. Mastrangelo F. Redaelli B. et al.Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters. The Italian Cooperative Dialysis Study Group.Kidney Int. 1996; 50: 1293-1302Crossref PubMed Scopus (265) Google Scholar Mortality was not significantly different among the 4 treatment groups, particularly between high-flux HD and high-flux HDF. Only by adding the 3 HD groups differing in membranes did Rabindranath et al1Rabindranath K.S. Strippoli G.F.M. Roderick P. Wallace S.A. MacLeod A.M. Daly C. Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD Systematic review.Am J Kidney Dis. 2005; 45: 437-447Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar find significant differences between HD and HDF. This procedure is not in accordance with a prospective randomized study. Surprisingly, the study by Ward et al3Ward R.A. Schmidt B. Hullin J. Hillebrand G.F. Samtleben W. A comparison of on-line hemodiafiltration and high-flux hemodialysis A prospective clinical study.J Am Soc Nephrol. 2000; 11: 2344-2350PubMed Google Scholar was not included in the meta-analysis. In general, it is believed that HDF is safe,4Nakai S. Iseki K. Tabei K. et al.Outcomes of hemodiafiltration based on Japanese dialysis patient registry.Am J Kidney Dis. 2001; 38: S212-S216Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar even in the long run.5Schiffl H. Lang S.M. Long-term crossover comparison of ultrapure high-flux haemodialysis and online haemodiafiltration A prospective 4 year clinical study.Blood Purif. 2004; 22 (abstr): 384Google Scholar Given the positive impacts on patient survival of higher treatment doses, high-flux membranes, preservation of residual renal function, and reduced systemic inflammation, HDF may reduce morbidity and mortality. Large randomized trials, such as the Dutch Convective Transport Study,6Penne E.L. Blankestijn P.J. Bots M.L. et al.Resolving controversies regarding hemodiafiltration versus hemodialysis The Dutch Convective Transport Study.Semin Dial. 2005; 18: 47-51Crossref PubMed Scopus (53) Google Scholar are needed. ALL LETTERS TO THE EDITOR MUST BE SUBMITTED ONLINE VIA EDITORIAL MANAGER (http://ajkd.edmgr.com). Letters should be in response to an AJKD article, and that article should have appeared no more than 6 months previously. The title must be different from that of the original article. Letters must not exceed 250 words (excluding references, maxi-mum number 10) and contain no more than 1 figure or table. Letters are subject to editing and abridgment without notice and there is no guarantee that your letter will be published. Submitting the letter constitutes your permission for its publication in any current or subse-quent issue or edition of AJKD, in any form or media, now known or hereafter developed. ALL LETTERS TO THE EDITOR MUST BE SUBMITTED ONLINE VIA EDITORIAL MANAGER (http://ajkd.edmgr.com). Letters should be in response to an AJKD article, and that article should have appeared no more than 6 months previously. The title must be different from that of the original article. Letters must not exceed 250 words (excluding references, maxi-mum number 10) and contain no more than 1 figure or table. Letters are subject to editing and abridgment without notice and there is no guarantee that your letter will be published. Submitting the letter constitutes your permission for its publication in any current or subse-quent issue or edition of AJKD, in any form or media, now known or hereafter developed.