Key result
Acetate-free biofiltration significantly lowered the risk of intradialytic hypotension compared to bicarbonate hemodialysis over 3 years (incidence rate ratio 0.60; 95% CI 0.53-0.68; p < 0.0001).
Why the study?
Does acetate-free biofiltration reduce long-term intradialytic hypotension rates compared to bicarbonate hemodialysis in new-to-dialysis patients?
RCT (n=371)
Yes
Does acetate-free biofiltration reduce long-term intradialytic hypotension rates compared to bicarbonate hemodialysis in new-to-dialysis patients?
Relative Risk: 0.6 (95% CI 0.53–0.68)
p-value: p=< 0.0001
Acetate-free biofiltration significantly reduces the long-term risk of intradialytic hypotension and lowers predialysis systolic blood pressure compared to bicarbonate hemodialysis in new-to-dialysis patients.
May support acetate-free biofiltration to reduce intradialytic hypotension in new dialysis patients; confirms long-term benefit in 3-year RCT.
BACKGROUND: Intradialytic hypotension (IH) is a common complication of bicarbonate hemodialysis (BD) and contributes to the intolerance of dialysis and the high cardiovascular morbidity and mortality among dialysis patients, the risk of which can be contained by convective therapies. AIMS/METHODS: To assess whether acetate-free biofiltration (AFB), a hemodiafiltration technique found to improve intradialytic cardiovascular stability in short-term studies, can influence long-term IH rates, predialysis systolic blood pressure (SBP), cardiovascular morbidity and mortality by comparison with BD, we analyzed data from a randomized controlled trial enrolling 371 new-to-dialysis patients, 194 on BD and 177 on AFB. RESULTS: During a 3-year follow-up, AFB carried a significantly lower risk of IH (incidence rate ratio 0.60 (95% CI 0.53-0.68), p < 0.0001). SBP dropped on AFB (p = 0.01), while it did not change on BD. Cardiovascular morbidity and mortality were similar between AFB and BD. CONCLUSION: AFB carries a lower long-term IH rate and reduces SBP by comparison with BD.
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Tessitore et al. (2012) conducted an RCT in End-stage renal disease requiring dialysis (n=371). Acetate-free biofiltration (AFB) vs. Bicarbonate hemodialysis (BD) was evaluated on Intradialytic hypotension (IH) rates (IRR 0.60, 95% CI 0.53-0.68, p=< 0.0001). Acetate-free biofiltration significantly lowered the risk of intradialytic hypotension compared to bicarbonate hemodialysis over 3 years (incidence rate ratio 0.60; 95% CI 0.53-0.68; p < 0.0001).
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