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Paweena Susantitaphong - One of the best experts on this subject based on the ideXlab platform.
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convective therapies versus low flux hemodialysis for Chronic Kidney Failure a meta analysis of randomized controlled trials
Nephrology Dialysis Transplantation, 2013Co-Authors: Monchai Siribamrungwong, Paweena Susantitaphong, Bertrand L. JaberAbstract:BACKGROUND: Although convective therapies have gained popularity for the optimal removal of uremic solutes, their benefits and potential risks have not been fully elucidated. We conducted a meta-analysis of all randomized controlled trials comparing convective therapies with low-flux hemodialysis in patients with Chronic Kidney Failure. METHODS: We performed a literature search using MEDLINE (inception-December 2012), Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, scientific abstracts from meetings and bibliographies of retrieved articles. Randomized controlled trials comparing the effect of convective therapies including high-flux hemodialysis, hemofiltration or hemodiafiltration versus low-flux hemodialysis were included. Random-effects model meta-analyses were used to examine continuous and binary outcomes. RESULTS: Sixty-five (29 crossover and 36 parallel-arm) trials were identified (n = 12 182). Convective therapies resulted in a decrease in all-cause mortality [relative risk (RR) 0.88; 95% confidence interval (CI) 0.76, 1.02, P = 0.09], cardiovascular mortality (RR 0.84; 95% CI 0.71, 0.98, P = 0.03), all-cause hospitalization (RR 0.91; 95% CI 0.82, 1.01; P = 0.08) and therapy-related hypotension (RR 0.55, 95% CI 0.35, 0.87, P = 0.01). Convective therapies also resulted in an increase in the clearance of several low-molecular-weight (urea, creatinine and phosphate), middle-sized (β-2 microglobulin and leptin) and protein-bound (homocysteine, advanced glycation end-products and pentosidine) solutes and a decrease in inflammatory markers (interleukin-6). There was no impact of convective therapies on cardiac morphological and functional parameters, and blood pressure and anemia parameters. CONCLUSIONS: Although convective therapies are associated with improved clearance of uremic solutes, the potential long-term benefits of specific convective modalities require further study.
Adrian Covic - One of the best experts on this subject based on the ideXlab platform.
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Original Investigation Convective Versus Diffusive Dialysis Therapies for Chronic Kidney Failure: An Updated Systematic Review of Randomized Controlled Trials
2020Co-Authors: Ionut Nistor, Adrian Covic, Suetonia C Palmer, Jonathan C Craig, Valeria Saglimbene, Mariacristina Vecchio, Giovanni F M StrippoliAbstract:Background: Convective dialysis therapies (hemofiltration or hemodiafiltration) are associated with lower mortality compared to hemodialysis in observational studies. A previous meta-analysis of randomized trials comparing convective modalities with hemodialysis in 2006 was inconclusive due to insufficient data. Additional randomized trials recently have reported conflicting results. Study Design: Systematic review and meta-analysis of randomized trials to February 27, 2013. Setting & Population: Patients with Chronic Kidney Failure treated by hemodialysis, hemodiafiltration, hemofiltration, or biofiltration. Selection Criteria for Studies: Randomized controlled trials. Intervention: Convective therapies (hemodiafiltration, hemofiltration, and acetate-free biofiltration) compared with hemodialysis. Outcomes: All-cause and cardiovascular mortality, nonfatal cardiovascular events, hospitalization, change in dialysis modality, health-related quality of life, adverse events, blood pressure, and clearances of urea and b2-microglobulin. Results: 35 trials (4,039 participants) were included. In low-quality evidence, convective dialysis had little or no effect on all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.70-1.07) and may reduce cardiovascular mortality (RR, 0.75; 95% CI, 0.58-0.97) and hypotension (RR, 0.72; 95% CI, 0.66-0.80) during dialysis, but had uncertain effects on nonfatal cardiovascular events (RR, 1.14; 95% CI, 0.85-1.52) and hospitalization (RR, 1.21; 95% CI, 0.12-12.05). Adverse events were not reported systematically and health-related quality-of-life outcomes were sparse. Convective therapies reduced predialysis levels of b2-microglobulin (mean difference, 25.77 [95% CI, 210.97 to 20.56] mg/dL) and increased dialysis dose (Kt/Vurea mean difference, 0.10; 95% CI, 0.02-0.19), but these effects were very heterogeneous. Sensitivity analyses limited to trials comparing hemodiafiltration with hemodialysis showed similar results. Limitations: Studies had important risks of bias leading to low confidence in the summary estimates and generally were limited to patients who had adequate dialysis vascular access. Conclusions: Treatment effects of convective dialysis are unreliable due to limitations in trial methods and reporting. Convective dialysis may reduce cardiovascular but not all-cause mortality, and effects on nonfatal cardiovascular events and hospitalization are inconclusive. Am J Kidney Dis. 63(6):954-967. a 2014 by the National Kidney Foundation, Inc.
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convective versus diffusive dialysis therapies for Chronic Kidney Failure an updated systematic review of randomized controlled trials
American Journal of Kidney Diseases, 2014Co-Authors: Ionut Nistor, Adrian Covic, Suetonia C Palmer, Jonathan C Craig, Valeria Saglimbene, Mariacristina Vecchio, Giovanni F M StrippoliAbstract:Background Convective dialysis therapies (hemofiltration or hemodiafiltration) are associated with lower mortality compared to hemodialysis in observational studies. A previous meta-analysis of randomized trials comparing convective modalities with hemodialysis in 2006 was inconclusive due to insufficient data. Additional randomized trials recently have reported conflicting results. Study Design Systematic review and meta-analysis of randomized trials to February 27, 2013. Setting & Population Patients with Chronic Kidney Failure treated by hemodialysis, hemodiafiltration, hemofiltration, or biofiltration. Selection Criteria for Studies Randomized controlled trials. Intervention Convective therapies (hemodiafiltration, hemofiltration, and acetate-free biofiltration) compared with hemodialysis. Outcomes All-cause and cardiovascular mortality, nonfatal cardiovascular events, hospitalization, change in dialysis modality, health-related quality of life, adverse events, blood pressure, and clearances of urea and β 2 -microglobulin. Results 35 trials (4,039 participants) were included. In low-quality evidence, convective dialysis had little or no effect on all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.70-1.07) and may reduce cardiovascular mortality (RR, 0.75; 95% CI, 0.58-0.97) and hypotension (RR, 0.72; 95% CI, 0.66-0.80) during dialysis, but had uncertain effects on nonfatal cardiovascular events (RR, 1.14; 95% CI, 0.85-1.52) and hospitalization (RR, 1.21; 95% CI, 0.12-12.05). Adverse events were not reported systematically and health-related quality-of-life outcomes were sparse. Convective therapies reduced predialysis levels of β 2 -microglobulin (mean difference, −5.77 [95% CI, −10.97 to −0.56]mg/dL) and increased dialysis dose (Kt/V urea mean difference, 0.10; 95% CI, 0.02-0.19), but these effects were very heterogeneous. Sensitivity analyses limited to trials comparing hemodiafiltration with hemodialysis showed similar results. Limitations Studies had important risks of bias leading to low confidence in the summary estimates and generally were limited to patients who had adequate dialysis vascular access. Conclusions Treatment effects of convective dialysis are unreliable due to limitations in trial methods and reporting. Convective dialysis may reduce cardiovascular but not all-cause mortality, and effects on nonfatal cardiovascular events and hospitalization are inconclusive.
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epidemiology contributors to and clinical trials of mortality risk in Chronic Kidney Failure
The Lancet, 2014Co-Authors: Alberto Ortiz, Adrian Covic, Danilo Fliser, Denis Fouque, David J Goldsmith, Mehmet Kanbay, Francesca Mallamaci, Ziad A Massy, Patrick RossignolAbstract:Summary Patients with Chronic Kidney Failure—defined as a glomerular filtration rate persistently below 15 mL/min per 1·73 m 2 —have an unacceptably high mortality rate. In developing countries, mortality results primarily from an absence of access to renal replacement therapy. Additionally, cardiovascular and non-cardiovascular mortality are several times higher in patients on dialysis or post-renal transplantation than in the general population. Mortality of patients on renal replacement therapy is affected by a combination of socioeconomic factors, pre-existing medical disorders, renal replacement treatment modalities, and Kidney Failure itself. Characterisation of the key pathophysiological contributors to increased mortality and cardiorenal risk staging systems are needed for the rational design of clinical trials aimed at decreasing mortality. Policy changes to improve access to renal replacement therapy should be combined with research into low-cost renal replacement therapy and optimum clinical care, which should include multifaceted approaches simultaneously targeting several of the putative contributors to increased mortality.
Giovanni F M Strippoli - One of the best experts on this subject based on the ideXlab platform.
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Original Investigation Convective Versus Diffusive Dialysis Therapies for Chronic Kidney Failure: An Updated Systematic Review of Randomized Controlled Trials
2020Co-Authors: Ionut Nistor, Adrian Covic, Suetonia C Palmer, Jonathan C Craig, Valeria Saglimbene, Mariacristina Vecchio, Giovanni F M StrippoliAbstract:Background: Convective dialysis therapies (hemofiltration or hemodiafiltration) are associated with lower mortality compared to hemodialysis in observational studies. A previous meta-analysis of randomized trials comparing convective modalities with hemodialysis in 2006 was inconclusive due to insufficient data. Additional randomized trials recently have reported conflicting results. Study Design: Systematic review and meta-analysis of randomized trials to February 27, 2013. Setting & Population: Patients with Chronic Kidney Failure treated by hemodialysis, hemodiafiltration, hemofiltration, or biofiltration. Selection Criteria for Studies: Randomized controlled trials. Intervention: Convective therapies (hemodiafiltration, hemofiltration, and acetate-free biofiltration) compared with hemodialysis. Outcomes: All-cause and cardiovascular mortality, nonfatal cardiovascular events, hospitalization, change in dialysis modality, health-related quality of life, adverse events, blood pressure, and clearances of urea and b2-microglobulin. Results: 35 trials (4,039 participants) were included. In low-quality evidence, convective dialysis had little or no effect on all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.70-1.07) and may reduce cardiovascular mortality (RR, 0.75; 95% CI, 0.58-0.97) and hypotension (RR, 0.72; 95% CI, 0.66-0.80) during dialysis, but had uncertain effects on nonfatal cardiovascular events (RR, 1.14; 95% CI, 0.85-1.52) and hospitalization (RR, 1.21; 95% CI, 0.12-12.05). Adverse events were not reported systematically and health-related quality-of-life outcomes were sparse. Convective therapies reduced predialysis levels of b2-microglobulin (mean difference, 25.77 [95% CI, 210.97 to 20.56] mg/dL) and increased dialysis dose (Kt/Vurea mean difference, 0.10; 95% CI, 0.02-0.19), but these effects were very heterogeneous. Sensitivity analyses limited to trials comparing hemodiafiltration with hemodialysis showed similar results. Limitations: Studies had important risks of bias leading to low confidence in the summary estimates and generally were limited to patients who had adequate dialysis vascular access. Conclusions: Treatment effects of convective dialysis are unreliable due to limitations in trial methods and reporting. Convective dialysis may reduce cardiovascular but not all-cause mortality, and effects on nonfatal cardiovascular events and hospitalization are inconclusive. Am J Kidney Dis. 63(6):954-967. a 2014 by the National Kidney Foundation, Inc.
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convective versus diffusive dialysis therapies for Chronic Kidney Failure an updated systematic review of randomized controlled trials
American Journal of Kidney Diseases, 2014Co-Authors: Ionut Nistor, Adrian Covic, Suetonia C Palmer, Jonathan C Craig, Valeria Saglimbene, Mariacristina Vecchio, Giovanni F M StrippoliAbstract:Background Convective dialysis therapies (hemofiltration or hemodiafiltration) are associated with lower mortality compared to hemodialysis in observational studies. A previous meta-analysis of randomized trials comparing convective modalities with hemodialysis in 2006 was inconclusive due to insufficient data. Additional randomized trials recently have reported conflicting results. Study Design Systematic review and meta-analysis of randomized trials to February 27, 2013. Setting & Population Patients with Chronic Kidney Failure treated by hemodialysis, hemodiafiltration, hemofiltration, or biofiltration. Selection Criteria for Studies Randomized controlled trials. Intervention Convective therapies (hemodiafiltration, hemofiltration, and acetate-free biofiltration) compared with hemodialysis. Outcomes All-cause and cardiovascular mortality, nonfatal cardiovascular events, hospitalization, change in dialysis modality, health-related quality of life, adverse events, blood pressure, and clearances of urea and β 2 -microglobulin. Results 35 trials (4,039 participants) were included. In low-quality evidence, convective dialysis had little or no effect on all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.70-1.07) and may reduce cardiovascular mortality (RR, 0.75; 95% CI, 0.58-0.97) and hypotension (RR, 0.72; 95% CI, 0.66-0.80) during dialysis, but had uncertain effects on nonfatal cardiovascular events (RR, 1.14; 95% CI, 0.85-1.52) and hospitalization (RR, 1.21; 95% CI, 0.12-12.05). Adverse events were not reported systematically and health-related quality-of-life outcomes were sparse. Convective therapies reduced predialysis levels of β 2 -microglobulin (mean difference, −5.77 [95% CI, −10.97 to −0.56]mg/dL) and increased dialysis dose (Kt/V urea mean difference, 0.10; 95% CI, 0.02-0.19), but these effects were very heterogeneous. Sensitivity analyses limited to trials comparing hemodiafiltration with hemodialysis showed similar results. Limitations Studies had important risks of bias leading to low confidence in the summary estimates and generally were limited to patients who had adequate dialysis vascular access. Conclusions Treatment effects of convective dialysis are unreliable due to limitations in trial methods and reporting. Convective dialysis may reduce cardiovascular but not all-cause mortality, and effects on nonfatal cardiovascular events and hospitalization are inconclusive.
Bertrand L. Jaber - One of the best experts on this subject based on the ideXlab platform.
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convective therapies versus low flux hemodialysis for Chronic Kidney Failure a meta analysis of randomized controlled trials
Nephrology Dialysis Transplantation, 2013Co-Authors: Monchai Siribamrungwong, Paweena Susantitaphong, Bertrand L. JaberAbstract:BACKGROUND: Although convective therapies have gained popularity for the optimal removal of uremic solutes, their benefits and potential risks have not been fully elucidated. We conducted a meta-analysis of all randomized controlled trials comparing convective therapies with low-flux hemodialysis in patients with Chronic Kidney Failure. METHODS: We performed a literature search using MEDLINE (inception-December 2012), Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, scientific abstracts from meetings and bibliographies of retrieved articles. Randomized controlled trials comparing the effect of convective therapies including high-flux hemodialysis, hemofiltration or hemodiafiltration versus low-flux hemodialysis were included. Random-effects model meta-analyses were used to examine continuous and binary outcomes. RESULTS: Sixty-five (29 crossover and 36 parallel-arm) trials were identified (n = 12 182). Convective therapies resulted in a decrease in all-cause mortality [relative risk (RR) 0.88; 95% confidence interval (CI) 0.76, 1.02, P = 0.09], cardiovascular mortality (RR 0.84; 95% CI 0.71, 0.98, P = 0.03), all-cause hospitalization (RR 0.91; 95% CI 0.82, 1.01; P = 0.08) and therapy-related hypotension (RR 0.55, 95% CI 0.35, 0.87, P = 0.01). Convective therapies also resulted in an increase in the clearance of several low-molecular-weight (urea, creatinine and phosphate), middle-sized (β-2 microglobulin and leptin) and protein-bound (homocysteine, advanced glycation end-products and pentosidine) solutes and a decrease in inflammatory markers (interleukin-6). There was no impact of convective therapies on cardiac morphological and functional parameters, and blood pressure and anemia parameters. CONCLUSIONS: Although convective therapies are associated with improved clearance of uremic solutes, the potential long-term benefits of specific convective modalities require further study.
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Low estimated glomerular filtration rate and Chronic Kidney Failure following liver transplant: a retrospective cohort study.
International Journal of Artificial Organs, 2013Co-Authors: Roberto Camargo Narciso, Leonardo Jose Rolim Ferraz, Cassio José De Oliveira Rodrigues, Julio Cesar Martins Monte, Oscar Fernando Pavão Dos Santos, Ângela Tavares Paes, Miguel Cendoroglo, Bertrand L. Jaber, Marcelino De Souza DurãoAbstract:BACKGROUND: Patients undergoing orthotropic liver transplant (LTx) often present with Chronic Kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of Kidney protective measures but also simultaneous Kidney transplant. STUDY DESIGN: Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes. RESULTS: 331 patients, who underwent LTx, were followed up for 2.6 ± 1.4 years; 31 (10%) developed ESRD, 6 (2%) underwent Kidney transplant after LTx and 25 (8%) remained on Chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m2 had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft Failure (HR = 3.95, 95% CI 1.73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction. CONCLUSION: These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. The consideration for Kidney after liver transplant as a treatment modality should be taken into account for those who develop Chronic Kidney Failure after LTx.
Raymond T. Krediet - One of the best experts on this subject based on the ideXlab platform.
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Lymphangiogenesis and Lymphatic Absorption Are Related and Increased in Chronic Kidney Failure, Independent of Exposure to Dialysis Solutions.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 2020Co-Authors: Carmen A. Vlahu, Jan Aten, Dirk G. Struijk, De Graaff M, Raymond T. KredietAbstract:: Increased lymphatic absorption might contribute to ultrafiltration Failure in peritoneal dialysis (PD). Lymphangiogenesis develops during PD, but little is known about the relationship between its morphologic and functional parameters. The relationships between lymph vessel density, the effective lymphatic absorption rate (ELAR), and fibrosis were investigated in a rat model of Chronic Kidney Failure (CKD) with exposure to dialysis solutions. Wistar rats (n = 44) were allocated to these groups: NKF (normal Kidney function), CKD (70% nephrectomy), CKDD [CKD, with daily intraperitoneal (i.p.) Dianeal 3.86% (Baxter Healthcare BV, Utrecht, Netherlands)], CKDP [CKD, with daily i.p. Physioneal 3.86% (Baxter Healthcare BV)]. After 16 weeks, a peritoneal function test was performed, and the ELAR was calculated from the disappearance rate of i.p. dextran 70. The lymph vessel profile density (LVPD) was assessed using STEPanizer image analysis (Java application from Tschanz SA, Bern, Germany) of omental sections after anti-podoplanin immunostaining. Fibrosis was quantified by picro-sirius red staining. The LVPD was significantly increased in CKD rats compared with NKF rats, and no additional effect of dialysis solutions was present. The ELAR was increased in uremic rats compared with NKF rats. For all rats together, the LVPD correlated positively with the ELAR and with the amount of fibrosis. Chronic Kidney disease itself induces lymphangiogenesis and fibrosis and increases the ELAR, independent of exposure to dialysis fluids. The ELAR is related to the LVPD in peritoneal tissue.
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preservation of residual Kidney function and urine volume in patients on dialysis
Clinical Journal of The American Society of Nephrology, 2017Co-Authors: Raymond T. KredietAbstract:Chronic dialysis treatment usually starts before the development of anuria to prevent the major complications of the uremic syndrome. Consequently, most patients will still have urine production at this time. Hemodialysis (HD) has been the main dialysis modality for Chronic Kidney Failure since its
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New Insights into the Effects of Chronic Kidney Failure and Dialysate Exposure on the Peritoneum
Peritoneal Dialysis International, 2016Co-Authors: Carmen A. Vlahu, Jan Aten, Marijke De Graaff, Henk A. Van Veen, Vincent Everts, Dirk R. De Waart, Dirk G. Struijk, Raymond T. KredietAbstract:: ♦ INTRODUCTION: Chronic uremia and the exposure to dialysis solutions during peritoneal dialysis (PD) induce peritoneal alterations. Using a long-term peritoneal exposure model, we compared the effects of Chronic Kidney Failure (CKD) itself and exposure to either a 'conventional' or a 'biocompatible' dialysis solution on peritoneal morphology and function. ♦ METHODS: Wistar rats (Harlan, Zeist, the Netherlands) were grouped into: normal Kidney function (NKF), CKD induced by 70% nephrectomy, CKD receiving daily peritoneal infusions with 3.86% glucose Dianeal (CKDD), or Physioneal (both solutions from Baxter Healthcare, Castlebar, Ireland) (CKDP). At 16 weeks, a peritoneal function test was performed, and histology, ultrastructure, and hydroxyproline content of peritoneal tissue were assessed. ♦ RESULTS: Comparing CKD with NKF, peritoneal transport rates were higher, mesothelial cells (MC) displayed increased number of microvilli, blood and lymph vasculature expanded, vascular basal lamina appeared thicker, with limited areas of duplication, and fibrosis had developed. All alterations, except lymphangiogenesis, were enhanced by exposure to both dialysis fluids. Distinct MC alterations were observed in CKDD and CKDP, the latter displaying prominent basolateral protrusions. In addition, CKDP was associated with a trend towards less fibrosis compared to CKDD. ♦ CONCLUSIONS: Chronic Kidney Failure itself induced peritoneal alterations, which were in part augmented by exposure to glucose-based dialysis solutions. Overall, the conventional and biocompatible solutions had similar long-term effects on the peritoneum. Importantly, the latter may attenuate the development of fibrosis.