Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: The effect of adjustment for body size

Andrew Davenport, Sanne A.E. Peters, Michiel L. Bots, Bernard Canaud, Muriel P.C. Grooteman, Gulay Asci, Francesco Locatelli, Francisco Maduell, Marion Morena, Menso J. Nubé, Ercan Ok, Ferran Torres, Mark Woodward, Peter J. Blankestijn

Research output: Contribution to journalArticle

Abstract

Mortality remains high for hemodialysis patients. Online hemodiafiltration (OL-HDF) removes more middle-sized uremic toxins but outcomes of individual trials comparing OL-HDF with hemodialysis have been discrepant. Secondary analyses reported higher convective volumes, easier to achieve in larger patients, and improved survival. Here we tested different methods to standardize OL-HDF convection volume on all-cause and cardiovascular mortality compared with hemodialysis. Pooled individual patient analysis of four prospective trials compared thirds of delivered convection volume with hemodialysis. Convection volumes were either not standardized or standardized to weight, body mass index, body surface area, and total body water. Data were analyzed by multivariable Cox proportional hazards modeling from 2793 patients. All-cause mortality was reduced when the convective dose was unstandardized or standardized to body surface area and total body water; hazard ratio (95% confidence intervals) of 0.65 (0.51-0.82), 0.74 (0.58-0.93), and 0.71 (0.56-0.93) for those receiving higher convective doses. Standardization by body weight or body mass index gave no significant survival advantage. Higher convection volumes were generally associated with greater survival benefit with OL-HDF, but results varied across different ways of standardization for body size. Thus, further studies should take body size into account when evaluating the impact of delivered convection volume on mortality end points.

Original languageEnglish (US)
Pages (from-to)193-199
Number of pages7
JournalKidney international
Volume89
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • Kt/V
  • body composition
  • body mass index
  • body surface area
  • hemodiafiltration
  • total body water

ASJC Scopus subject areas

  • Nephrology

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    Davenport, A., Peters, S. A. E., Bots, M. L., Canaud, B., Grooteman, M. P. C., Asci, G., Locatelli, F., Maduell, F., Morena, M., Nubé, M. J., Ok, E., Torres, F., Woodward, M., & Blankestijn, P. J. (2016). Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: The effect of adjustment for body size. Kidney international, 89(1), 193-199. https://doi.org/10.1038/ki.2015.264