Predilution online hemodiafiltration is associated with improved survival compared with hemodialysis
Predilution online hemodiafiltration is associated with improved survival compared with hemodialysis
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DOI：
10.1016/j.kint.2018.10.036
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发表时间：
2019-04-01
影响因子：
19.6
通讯作者：
Masakane, Ikuto
中科院分区：
文献类型：
--
作者：
Kikuchi, Kan;Hamano, Takayuki;Masakane, Ikuto
根据稀释后在线血液滤过的随机对照试验结果，在线血液滤过在一些国家越来越普遍地成为慢性血液透析的替代方案。日本目前有6万多名患者接受在线血液透析滤过治疗，其中95%以上使用预稀释在线血液透析滤过；然而，缺乏这种模式的临床结果的大规模数据。2012年12月31日至2013年12月31日，我们使用日本透析治疗学会肾脏数据注册数据库，创建了一个5000对接受传统血液透析或预稀释在线血液滤过治疗的患者的倾向匹配队列。比较两组一年的全因死亡率和心血管死亡率。与血液透析相比，预稀释在线血液滤过与改善总生存率相关（全因死亡率风险比0.83,95%可信区间0.705-0.986），并有改善心血管生存率的趋势。在接受预稀释在线血液滤过治疗的患者中，与接受低替代量治疗的患者相比，接受高替代量治疗的患者（>= 40.0 L /次）的全因生存和心血管生存得到改善(
On-line hemodiafiltration is an increasingly common alternative to chronic hemodialysis in some countries, based on the results of randomized controlled trials of post-dilution on-line hemodiafiltration. There are now more than 60,000 patients treated with on-line hemodialfiltration in Japan, over 95% of whom use predilution on-line hemodiafiltration; however, large-scale data on clinical outcomes with this modality are lacking. We created a propensity-matched cohort of 5,000 pairs of patients treated with conventional hemodialysis or predilution on-line hemodiafiltration, using the Japanese Society for Dialysis Therapy Renal Data Registry database from December 31, 2012 to December 31, 2013. One-year all-cause and cardiovascular mortality were compared between the groups. Predilution on-line hemodiafiltration was associated with improved overall survival compared to hemodialysis (hazard ratio for all cause-mortality 0.83, 95% confidence interval 0.705-0.986), with a trend towards improved cardiovascular survival. Among patients treated with predilution on-line hemodiafiltration, those treated with high substitution volumes (>= 40.0 L per session) had improved all-cause and cardiovascular survival compared to those treated with low substitution volumes (