Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments

Francesco Locatelli, Daniele Marcelli, Ferruccio Conte, Aurelio Limido, Fabio Malberti, Donatella Spotti

Research output: Contribution to journalArticle

203 Citations (Scopus)

Abstract

Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments. Background. The aim of this study was to evaluate the effect of convective [hemodiafiltration (HDF) or hemofiltration (HF)] versus diffusive treatments [hemodialysis (HD)] on end-stage renal disease (ESRD) patient mortality and dialysis-related amyloidosis (DRA) using data from the Lombardy Registry. Methods. For this purpose, 6,444 patients (aged 56.4 ± 15.6 years, females 39.5%, diabetics 10.6%) who started renal replacement therapy (RRT) oil HD, HDF, or HF between 1983 and 1995 were considered. A total of 1,082 patients were treated with HDF or HF (first choice in the case of 188), with a median follow-up of 29.7 months. The median follow-up of the 6,298 patients on HD (first choice in the case of 6256) was 22.4 months. The time of survival on dialysis to carpal tunnel syndrome (CTS) surgery was evaluated as a hard marker of DRA morbidity. Survival was compared by means of the Cox proportional regression hazards model, using CTS surgery and all deaths as events for morbidity and mortality, respectively. Explanatory covariates were age, gender, and comorbidities; dialysis modality was tested as a time-dependent covariate. Results. The relative risk (RR) for CTS surgery was significantly higher in older patients [RR = 1.04 per year of age on admission to RRT, 95% confidence interval (CI) 1.02 to 1.06; P = 0.0001], in diabetics (RR = 2.63, 95% CI 1.30 to 5.31; P = 0.0007), and in patients with heart disease (RR = 5.36, 95% CI 2.27 to 12.68 P = 0.0001). Adjusting for age and diabetic status, the RR for CTS surgery was 42% lower in the patients treated with HDF or HF (RR = 0.58, 95% CI 0.35 to 0.95, P = 0.03). The RR for mortality, adjusted for age, gender, and comorbidities, was 10% lower in patients treated with HDF or HF (RR = 0.90, 95% CI 0.76 to 1.06; P = Ns). Conclusion. These results support the hypothesis that convective treatments are associated with a nonsignificant trend toward better survival and significantly delay the need for CTS surgery. An older age and the presence of diabetes and heart disease are other important risk factors for CTS surgery. These results could have an important clinical impact given the relevance of DRA in dialysis patient morbidity.

Original languageEnglish
Pages (from-to)286-293
Number of pages8
JournalKidney International
Volume55
Issue number1
DOIs
Publication statusPublished - 1999

Fingerprint

Chronic Kidney Failure
Carpal Tunnel Syndrome
Hemodiafiltration
Hemofiltration
Mortality
Dialysis
Confidence Intervals
Amyloidosis
Renal Dialysis
Therapeutics
Renal Replacement Therapy
Morbidity
Survival
Comorbidity
Heart Diseases
Proportional Hazards Models
Registries
Oils

Keywords

  • Carpal tunnel syndrome
  • Dialysis related amyloidosis
  • Hemodiafiltration
  • Hemodialysis
  • Renal replacement therapy

ASJC Scopus subject areas

  • Nephrology

Cite this

Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments. / Locatelli, Francesco; Marcelli, Daniele; Conte, Ferruccio; Limido, Aurelio; Malberti, Fabio; Spotti, Donatella.

In: Kidney International, Vol. 55, No. 1, 1999, p. 286-293.

Research output: Contribution to journalArticle

Locatelli, F, Marcelli, D, Conte, F, Limido, A, Malberti, F & Spotti, D 1999, 'Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments', Kidney International, vol. 55, no. 1, pp. 286-293. https://doi.org/10.1046/j.1523-1755.1999.00236.x
Locatelli, Francesco ; Marcelli, Daniele ; Conte, Ferruccio ; Limido, Aurelio ; Malberti, Fabio ; Spotti, Donatella. / Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments. In: Kidney International. 1999 ; Vol. 55, No. 1. pp. 286-293.
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title = "Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments",
abstract = "Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments. Background. The aim of this study was to evaluate the effect of convective [hemodiafiltration (HDF) or hemofiltration (HF)] versus diffusive treatments [hemodialysis (HD)] on end-stage renal disease (ESRD) patient mortality and dialysis-related amyloidosis (DRA) using data from the Lombardy Registry. Methods. For this purpose, 6,444 patients (aged 56.4 ± 15.6 years, females 39.5{\%}, diabetics 10.6{\%}) who started renal replacement therapy (RRT) oil HD, HDF, or HF between 1983 and 1995 were considered. A total of 1,082 patients were treated with HDF or HF (first choice in the case of 188), with a median follow-up of 29.7 months. The median follow-up of the 6,298 patients on HD (first choice in the case of 6256) was 22.4 months. The time of survival on dialysis to carpal tunnel syndrome (CTS) surgery was evaluated as a hard marker of DRA morbidity. Survival was compared by means of the Cox proportional regression hazards model, using CTS surgery and all deaths as events for morbidity and mortality, respectively. Explanatory covariates were age, gender, and comorbidities; dialysis modality was tested as a time-dependent covariate. Results. The relative risk (RR) for CTS surgery was significantly higher in older patients [RR = 1.04 per year of age on admission to RRT, 95{\%} confidence interval (CI) 1.02 to 1.06; P = 0.0001], in diabetics (RR = 2.63, 95{\%} CI 1.30 to 5.31; P = 0.0007), and in patients with heart disease (RR = 5.36, 95{\%} CI 2.27 to 12.68 P = 0.0001). Adjusting for age and diabetic status, the RR for CTS surgery was 42{\%} lower in the patients treated with HDF or HF (RR = 0.58, 95{\%} CI 0.35 to 0.95, P = 0.03). The RR for mortality, adjusted for age, gender, and comorbidities, was 10{\%} lower in patients treated with HDF or HF (RR = 0.90, 95{\%} CI 0.76 to 1.06; P = Ns). Conclusion. These results support the hypothesis that convective treatments are associated with a nonsignificant trend toward better survival and significantly delay the need for CTS surgery. An older age and the presence of diabetes and heart disease are other important risk factors for CTS surgery. These results could have an important clinical impact given the relevance of DRA in dialysis patient morbidity.",
keywords = "Carpal tunnel syndrome, Dialysis related amyloidosis, Hemodiafiltration, Hemodialysis, Renal replacement therapy",
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T1 - Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments

AU - Locatelli, Francesco

AU - Marcelli, Daniele

AU - Conte, Ferruccio

AU - Limido, Aurelio

AU - Malberti, Fabio

AU - Spotti, Donatella

PY - 1999

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N2 - Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments. Background. The aim of this study was to evaluate the effect of convective [hemodiafiltration (HDF) or hemofiltration (HF)] versus diffusive treatments [hemodialysis (HD)] on end-stage renal disease (ESRD) patient mortality and dialysis-related amyloidosis (DRA) using data from the Lombardy Registry. Methods. For this purpose, 6,444 patients (aged 56.4 ± 15.6 years, females 39.5%, diabetics 10.6%) who started renal replacement therapy (RRT) oil HD, HDF, or HF between 1983 and 1995 were considered. A total of 1,082 patients were treated with HDF or HF (first choice in the case of 188), with a median follow-up of 29.7 months. The median follow-up of the 6,298 patients on HD (first choice in the case of 6256) was 22.4 months. The time of survival on dialysis to carpal tunnel syndrome (CTS) surgery was evaluated as a hard marker of DRA morbidity. Survival was compared by means of the Cox proportional regression hazards model, using CTS surgery and all deaths as events for morbidity and mortality, respectively. Explanatory covariates were age, gender, and comorbidities; dialysis modality was tested as a time-dependent covariate. Results. The relative risk (RR) for CTS surgery was significantly higher in older patients [RR = 1.04 per year of age on admission to RRT, 95% confidence interval (CI) 1.02 to 1.06; P = 0.0001], in diabetics (RR = 2.63, 95% CI 1.30 to 5.31; P = 0.0007), and in patients with heart disease (RR = 5.36, 95% CI 2.27 to 12.68 P = 0.0001). Adjusting for age and diabetic status, the RR for CTS surgery was 42% lower in the patients treated with HDF or HF (RR = 0.58, 95% CI 0.35 to 0.95, P = 0.03). The RR for mortality, adjusted for age, gender, and comorbidities, was 10% lower in patients treated with HDF or HF (RR = 0.90, 95% CI 0.76 to 1.06; P = Ns). Conclusion. These results support the hypothesis that convective treatments are associated with a nonsignificant trend toward better survival and significantly delay the need for CTS surgery. An older age and the presence of diabetes and heart disease are other important risk factors for CTS surgery. These results could have an important clinical impact given the relevance of DRA in dialysis patient morbidity.

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KW - Carpal tunnel syndrome

KW - Dialysis related amyloidosis

KW - Hemodiafiltration

KW - Hemodialysis

KW - Renal replacement therapy

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