Introduction and Aims: The exact role of the absence of acetate in dialysate has not yet been clarified in randomized studies. Previous trials focused on intradialytic symptoms, where as few studies have attempted to obtain a better survival and a lower morbidity with AFB. To evaluate whether AFB may alter long-term mortality compared to BD, we conducted a CREMS in 362 incidents, critically ill CD pts, defined as elderly (>60 y old) orhypotension prone (≥5 hypotensive episodes/month) or diabetics, from 94 European Dialysis Centres during the period 1998 – 2003.Methods: Pts (211 male, 151 female, aged 68±9 y) were allocated to BD (192 pts) or to AFB (170 pts) by block randomization. The role of BD or AFB treatment, adjusted for baseline demographics, co-morbidities (as measured by the Charlson Co-morbidity Index, CCI), BMI, predialysis systolic blood pressure (pSBP) (stratifying pts in: normotensives, N, if pSBP <140 mmHg, mildly hypertensives, MH, if pSBP 140 -160 mmHg, severe hypertensives, SH, if pSBP >160 mmHg), left ventricular mass (LVM), lipids, spKt/V, hemoglobin, albumin, Ca-P product as predictors of 4-y all-cause (ACM) and cardiovascular (CVM) mortality, was evaluated by Cox’s analysis.Results: The two groups were homogeneous for baseline characteristics, except for the higher prevalence of hypotension-prone pts in AFB (39.4% vs 26.6% in BD; p=0.010). Drop out were 20% in BD and 24% in AFB.ACM was 30% in BD and 33% in AFB with an average annual mortality rate of 11.3%. Deaths for CV disease were 22% in BD and 15% in AFB (p=0.010). Vascular access (HR 1.88; 95%CI 1.02-3.46 CVC/PTFE vs AVF; p=0.043), higher baseline CCI (HR 1.22; 95%CI 1.07-1.39; p=0.002) and left ventricular hypertrophy (LVH) (HR 1.68; 95%CI 1.05-2.71; p=0.032)were significant predictors of ACM. CCI (HR 1.26; 95%CI 1.08-3.46; p=0.004) and Ca-P product (HR 1.02; 95%CI 1.00-1.03; p=0.039) were the only predictors of CVM.Treatment modality, indeed, as well as CCI, and change in pSBP during the follow-up were significant determinants in the large subset of mild hypertensive pts (Table).
A controlled randomized european multicenter study (CREMS) on mortality in chronic dialysis (CD) patients: a comparison between acetate-free biofiltration (AFB) and conventional bycarbonate dialysis (BD)
POLI, Albino
2007-01-01
Abstract
Introduction and Aims: The exact role of the absence of acetate in dialysate has not yet been clarified in randomized studies. Previous trials focused on intradialytic symptoms, where as few studies have attempted to obtain a better survival and a lower morbidity with AFB. To evaluate whether AFB may alter long-term mortality compared to BD, we conducted a CREMS in 362 incidents, critically ill CD pts, defined as elderly (>60 y old) orhypotension prone (≥5 hypotensive episodes/month) or diabetics, from 94 European Dialysis Centres during the period 1998 – 2003.Methods: Pts (211 male, 151 female, aged 68±9 y) were allocated to BD (192 pts) or to AFB (170 pts) by block randomization. The role of BD or AFB treatment, adjusted for baseline demographics, co-morbidities (as measured by the Charlson Co-morbidity Index, CCI), BMI, predialysis systolic blood pressure (pSBP) (stratifying pts in: normotensives, N, if pSBP <140 mmHg, mildly hypertensives, MH, if pSBP 140 -160 mmHg, severe hypertensives, SH, if pSBP >160 mmHg), left ventricular mass (LVM), lipids, spKt/V, hemoglobin, albumin, Ca-P product as predictors of 4-y all-cause (ACM) and cardiovascular (CVM) mortality, was evaluated by Cox’s analysis.Results: The two groups were homogeneous for baseline characteristics, except for the higher prevalence of hypotension-prone pts in AFB (39.4% vs 26.6% in BD; p=0.010). Drop out were 20% in BD and 24% in AFB.ACM was 30% in BD and 33% in AFB with an average annual mortality rate of 11.3%. Deaths for CV disease were 22% in BD and 15% in AFB (p=0.010). Vascular access (HR 1.88; 95%CI 1.02-3.46 CVC/PTFE vs AVF; p=0.043), higher baseline CCI (HR 1.22; 95%CI 1.07-1.39; p=0.002) and left ventricular hypertrophy (LVH) (HR 1.68; 95%CI 1.05-2.71; p=0.032)were significant predictors of ACM. CCI (HR 1.26; 95%CI 1.08-3.46; p=0.004) and Ca-P product (HR 1.02; 95%CI 1.00-1.03; p=0.039) were the only predictors of CVM.Treatment modality, indeed, as well as CCI, and change in pSBP during the follow-up were significant determinants in the large subset of mild hypertensive pts (Table).
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
