Robin W M Vernooij1,2, Way Law1,3, Sanne A E Peters2,4,5, Bernard Canaud6,7, Andrew Davenport8, Muriel P C Grooteman9, Fatih Kircelli10, Francesco Locatelli11, Francisco Maduell12, Marion Morena13, Menso J Nubé9, Ercan Ok10, Ferran Torres14,15, Mark Woodward4,5,16, Peter J Blankestijn17, Michiel L Bots2. 1. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 3. Wai-ping Law, Renal unit, Department of medicine, Queen Elizabeth Hospital, Hong Kong, PR China. 4. The George Institute for Global Health, School of Public Health, Imperial College, London, UK. 5. The George Institute for Global Health, University of New South Wales, Sydney, Australia. 6. Global Medical Office, Fresenius Medical Care Deutschland, Bad Homburg, Germany. 7. Montpellier University, School of Medicine, Montpellier, France. 8. University College London, Centre for Nephrology, Royal Free Hospital, London, UK. 9. Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands. 10. Division of Nephrology, Ege University School of Medicine, Izmir, Turkey. 11. Department of Nephrology, Alessandro Manzoni Hospital, past director, Lecco, Italy. 12. Nephrology Department, Hospital Clinic, Barcelona, Spain. 13. PhyMedExp, University of Montpellier, INSERM, CNRS, Biochemistry/Hormonology department, University Hospital Center of Montpellier, Montpellier, France. 14. Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 15. Medical Statistics core facility, IDIBAPS, Hospital Clinic, Barcelona, Spain. 16. Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA. 17. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands. p.j.blankestijn@umcutrecht.nl.
Abstract
BACKGROUND: Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D. METHODS: Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study. RESULTS: After a median follow-up of 2.5 years (Q1 to Q3: 1.9-3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86-1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92-1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes. CONCLUSIONS: Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions.
BACKGROUND: Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D. METHODS: Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study. RESULTS: After a median follow-up of 2.5 years (Q1 to Q3: 1.9-3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86-1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92-1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes. CONCLUSIONS: Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions.
Authors: A O Ojo; J A Hanson; R A Wolfe; L Y Agodoa; S F Leavey; A Leichtman; E W Young; F K Port Journal: Kidney Int Date: 1999-05 Impact factor: 10.612
Authors: Ionut Nistor; Suetonia C Palmer; Jonathan C Craig; Valeria Saglimbene; Mariacristina Vecchio; Adrian Covic; Giovanni F M Strippoli Journal: Am J Kidney Dis Date: 2014-01-14 Impact factor: 8.860