Introduction and Aims: Acetate-free Biofiltration (AFB) has been shown to improve intradialytic hemodynamic stability in previous short-term studies, whereas very little is known on its long-term cardiovascular effects. We performed a 3-y prospective randomized European multicenter study to evaluate the cardiovascular effects of long-term AFB in incident CD patients (pts), compared to conventional bicarbonate dialysis (BD). Methods: Threehundred-sixtytwo pts (211 male, 151 female, aged 68±9 y) were enrolled and allocated to BD (n 192) or to AFB (n 170) by block randomization. Pts were stratified according to predialysis systolic blood pressure (pSBP) in normotensives (N) (pSBP <140 mmHg) (n 138: 69 on BD and 69 on AFB), mildly hypertensives (MH) (pSBP 140-160 mmHg) (n 146: 85 on BD and 61 on AFB) and severe hypertensives (SH)(pSBP >160 mmHg) (n 78: 38 on BD and 40 on AFB). Outcomes of the study were changes in pSBP, left ventricular mass (LVM) and intradialytic cardiovascular instability (defined as the appearance of intradialytic hypoand/or hypertensive episodes). The effects on cardiovascular mortality (CVM) were evaluated over 4-y follow-up. Results: During follow up, median pSBP did not change in BD (from 146 to 144 mmHg, p=0.127) and significantly decreased in AFB (from 145 to 138 mmHg, p=0.004). The pSBP changes in AFB were only significantly different from BD in MH (-5 vs -2 mmHg, p=0.050). The proportion of subjects with intradialytic cardiovascular instability was unchanged in BD (from 56 to 46%, p=0.196) and significantly decreased in AFB (from 69% to 44%, p=0.003). In the three subgroups, we observed the same pattern in favour of AFB. Median LVM tended to decrease in AFB (from 142 to 140 g/m2, p=0.597) while it increased in BD (from 137 to 142 g/m2, p=0.138) even though did not achieve the statistical significance. On the contrary, LVM in MH pts significantly increased in BD (from 133 to 148 g/m2, p=0.002) and did not change in AFB (from 157 to 155 g/m2, p=0.940). The proportion of pts who died for CV disease was higher in BD than AFB, in MH (27% vs 8%, p=0.005). In the same subgroup, significant determinants of CVM were CCI (HR 1.27, 95%CI 1.05 -1.55, p=0.015), treatment modality (AFB: HR 0.31, 95%CI 0.12-0.8, p=0.017) and the change in pSBP (HR 1.04, 95%CI 1.00-1.09, p=0.044). Conclusions: Our study shows that long-term AFB is associated with a better intra- and inter-dialytic blood pressure control than BD. Results also suggest that AFB reduces CVM in the mildly hypertensive patients, possibly via the reduction of pSBP, the better intradialytic cardiovascular stability, and the prevention of the increase in LVM
CARDIOVASCULAR EFFECTS OF ACETATE-FREE BIOFILTRATION (AFB) AND CONVENTIONAL BICARBONATE DIALYSIS (BD) IN CHRONIC DIALYSIS (CD) PATIENTS: A CONTROLLED RANDOMIZED EUROPEAN MULTICENTER STUDY
MANTOVANI, William
2007-01-01
Abstract
Introduction and Aims: Acetate-free Biofiltration (AFB) has been shown to improve intradialytic hemodynamic stability in previous short-term studies, whereas very little is known on its long-term cardiovascular effects. We performed a 3-y prospective randomized European multicenter study to evaluate the cardiovascular effects of long-term AFB in incident CD patients (pts), compared to conventional bicarbonate dialysis (BD). Methods: Threehundred-sixtytwo pts (211 male, 151 female, aged 68±9 y) were enrolled and allocated to BD (n 192) or to AFB (n 170) by block randomization. Pts were stratified according to predialysis systolic blood pressure (pSBP) in normotensives (N) (pSBP <140 mmHg) (n 138: 69 on BD and 69 on AFB), mildly hypertensives (MH) (pSBP 140-160 mmHg) (n 146: 85 on BD and 61 on AFB) and severe hypertensives (SH)(pSBP >160 mmHg) (n 78: 38 on BD and 40 on AFB). Outcomes of the study were changes in pSBP, left ventricular mass (LVM) and intradialytic cardiovascular instability (defined as the appearance of intradialytic hypoand/or hypertensive episodes). The effects on cardiovascular mortality (CVM) were evaluated over 4-y follow-up. Results: During follow up, median pSBP did not change in BD (from 146 to 144 mmHg, p=0.127) and significantly decreased in AFB (from 145 to 138 mmHg, p=0.004). The pSBP changes in AFB were only significantly different from BD in MH (-5 vs -2 mmHg, p=0.050). The proportion of subjects with intradialytic cardiovascular instability was unchanged in BD (from 56 to 46%, p=0.196) and significantly decreased in AFB (from 69% to 44%, p=0.003). In the three subgroups, we observed the same pattern in favour of AFB. Median LVM tended to decrease in AFB (from 142 to 140 g/m2, p=0.597) while it increased in BD (from 137 to 142 g/m2, p=0.138) even though did not achieve the statistical significance. On the contrary, LVM in MH pts significantly increased in BD (from 133 to 148 g/m2, p=0.002) and did not change in AFB (from 157 to 155 g/m2, p=0.940). The proportion of pts who died for CV disease was higher in BD than AFB, in MH (27% vs 8%, p=0.005). In the same subgroup, significant determinants of CVM were CCI (HR 1.27, 95%CI 1.05 -1.55, p=0.015), treatment modality (AFB: HR 0.31, 95%CI 0.12-0.8, p=0.017) and the change in pSBP (HR 1.04, 95%CI 1.00-1.09, p=0.044). Conclusions: Our study shows that long-term AFB is associated with a better intra- and inter-dialytic blood pressure control than BD. Results also suggest that AFB reduces CVM in the mildly hypertensive patients, possibly via the reduction of pSBP, the better intradialytic cardiovascular stability, and the prevention of the increase in LVM
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
