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Öğe Alpha-Galactosidase A Activity Levels in Turkish Male Hemodialysis Patients(Wiley, 2012) Ucar, Sema Kalkan; Sozmen, Eser; Duman, Soner; Basci, Ali; Coker, MahmutFabry disease is an X-linked lysosomal storage disorder due to deficient activity of alpha-galactosidase A (alpha-Gal A) leading to renal insufficiency in males. The aim of present study was to investigate the level of alpha-Gal A activity and to determine the prevalence of Fabry disease in a Turkish male hemodialysis population. The activity of plasma alpha-Gal A was measured in a group of 808 male hemodialysis patients using fluorimetric methods. Patients with low alpha-Gal A activity were evaluated clinically and genetic testing was carried out. A correlation with creatinine, uric acid, urea, white blood cell (WBC), and high sensitivity (hs)CRP and alpha-Gal A activity was also investigated. Plasma a-Gal A activity among this male population undergoing hemodialysis was 7.88 +/- 5.18 mu M/hour/L (0.4055.72), significantly lower when compared to controls. No influence of creatinine, uric acid, WBC, or hsCRP on measured alpha-Gal A activity was reported. Two new Fabry disease patients were identified. Both were previously diagnosed with diabetes mellitus type 2. These findings provide, for the first time, data regarding the prevalence of alpha-Gal A deficiency (0.24%) in Turkish males receiving hemodialysis.Öğe The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis(Oxford Univ Press, 2009) Kayikcioglu, Meral; Tumuklu, Murat; Ozkahya, Mehmet; Ozdogan, Oner; Asci, Gulay; Duman, Soner; Toz, Huseyin; Can, Levent H.; Basci, Ali; Ok, ErcanBackground. Most haemodialysis (HD) centres use anti-hypertensive drugs for the management of hypertension, whereas some centres apply dietary salt restriction strategy. In this retrospective cross-sectional study, we assessed the effectiveness and cardiac consequences of these two strategies. Methods. We enrolled all patients from two dialysis centres, who had been on a standard HD programme at the same centre for at least 1 year. All patients underwent echocardiographic evaluation. Clinical data were obtained from patients' charts. Centre A (n = 190) practiced 'salt restriction' strategy and Centre B (n = 204) practiced anti-hypertensive-based strategy. Salt restriction was defined as managing high blood pressure (BP) via lowering dry weight by strict salt restriction and insistent ultrafiltration without using anti-hypertensive drugs. Results. There was no difference regarding age, gender, diabetes, history of cardiovascular disease and efficiency of dialysis between centres. Antihypertensive drugs were used in 7% of the patients in Centre A and 42% in Centre B (P < 0.01); interdialytic weight gain was significantly lower in Centre A (2.29 +/- 0.83 kgversus 3.31 +/- 1.12 kg, P < 0.001). Mean systolic and diastolic blood pressures were similar in the two centres. However, Centre A had lower left ventricular (LV) mass (indexed for height(2.7): 59 +/- 16 versus 74 +/- 27 g/m(2.7), P < 0.0001). The frequency of LV hypertrophy was lower in Centre A (74% versus 88%, P < 0.001). Diastolic and systolic functions were better preserved in Centre A. Intradialytic hypotension (hypotensive episodes/100 patient sessions) was more frequent in Centre B (11 versus 27, P < 0.01). Conclusions. This cross-sectional study suggests that salt restriction and reduced prescription of antihypertensive drugs may limit LV hypertrophy, better preserve LV functions and reduce intradialytic hypotension in HD patients.Öğe Can Subtypes of White Blood Cells Predict Mortality in Hemodialysis Patients?(Ortadogu Ad Pres & Publ Co, 2011) Duman, Soner; Sazak, Hakan Savas; Baskan, Onur; Basci, AliObjective: To investigate whether increased white blood cell count (WBC) is an independent risk factor for mortality in hemodialysis (HD) patients. There are limited number of studies that evaluate the WBC subtypes and mortality in HD patients. Material and Methods: In this 36 months long prospective study, predictive value of WBC subtypes for mortality was investigated in 910 HD patients (male 55%, diabetes 29.3%, age 59 +/- 14; HD duration 44 +/- 39 months). Results: There was significant correlation between high sensitive C-reactive protein and neutrophils (r= 0.43, p< 0.001) and monocytes (r= 0.24, p< 0.001). During the study 202 (22%) patients died mainly of cardiovascular disease (%57). Survivals at 1,2 and 3 years were calculated with Kaplan Meier analysis and were found as 90%, 80% and %73, respectively. Kaplan Meier analysis showed that increased basal neutrophil count (>5.040/mm(3)), increased monocytes (>740/mm(3)) and decreased lymphocytes (<1.620/mm(3)) were correlated with poor survival. In Cox regression analysis, monocyte count over 1.267/mm(3) and lymphocyte count less than 461/mm(3) were found as independent factors for overall survival after correction for classical risk factors. However, neutrophil count was not correlated with mortality. Conclusion: Increased blood monocyte count and decreased lymphocyte count are independent risk factors for long-term mortality.Öğe Comparison of dialysates with and without glucose in hemodialysis patients(Oxford Univ Press, 2007) Asci, Gulay; Toz, Huseyin; Duman, Soner; Ozkahya, Mehmet; Sayin, Kerime; Kircelli, Fatih; Gunay, Ebru; Boydak, Can; Sipahi, Savas; Basci, Ali; Sever, Mehmet S.; Ok, ErcanÖğe EBPG guideline on haemodynarnic instabilty(Oxford Univ Press, 2007) Kooman, Jeroen; Basci, Ali; Pizzarelli, Francesco; Canaud, Bernard; Haage, Patrick; Fouque, Denis; Konner, Klaus; Martin-Malo, Alejandro; Pedrini, Luciano; Tattersallo, James; Tordoir, Jan; Vennegoor, Marianne; Warmer, Christoph; ter Wee, Piet; Vanholder, RaymondÖğe EBPG guideline on nutrition(Oxford Univ Press, 2007) Fouque, Denis; Vennegoor, Marianne; Ter Wee, Piet; Warnner, Christoph; Basci, Ali; Canaud, Bernard; Haage, Patrick; Konner, Klaus; Kooman, Jeroen; Martin-Malo, Alejandro; Pedrini, Lucianu; Pizzarelli, Francesco; Tattersall, James; Tordoir, Jan; Vanholder, RaymondÖğe Effects of thrice weekly nocturnal hemodialysis on arterial stiffness(Elsevier Ireland Ltd, 2012) Demirci, Meltem Sezis; Celik, Gulperi; Ozkahya, Mehmet; Tumuklu, Murat; Toz, Huseyin; Asci, Gulay; Duman, Soner; Basci, Ali; Kircelli, Fatih; Ozdogan, Oner; Demirci, Cenk; Can, Levent; Isik, Ismet Onder; Ok, ErcanObjective: In this study, we compared the changes in arterial stiffness in chronic hemodialysis patients treated with 8-h vs. 4-h thrice weekly in-center hemodialysis. Methods: Sixty prevalent chronic hemodialysis patients assigned to 8-h nocturnal in-center thrice weekly HD (NHD) and 60 control cases assigned to 4-h thrice weekly conventional HD (CHD) were followed for one year. Radial-carotid pulse wave velocity, augmentation index and echocardiography were performed at baseline and 12th month. Results: Mean age of the patients was 49 +/- 11 years, 30.8% were female, 27.5% had diabetes mellitus and mean dialysis vintage was 57 +/- 47 months. Baseline demographical, clinical and laboratory parameters were similar between groups. During a mean follow-up of 15.0 +/- 0.1 months, blood pressure remained similar in both groups while the number of mean daily anti-hypertensive substances decreased in the NHD group. In the NHD group, time-averaged serum phosphorus and calcium-phosphorus product were lower than the CHD group. Pulse wave velocity and augmentation index decreased in the NHD group (from 11.02 perpendicular to 2.51 m/s to 9.61 perpendicular to 2.39 m/s and from 28.8 perpendicular to 10.3% to 26.2 perpendicular to 12.1%; p = 0.008 and p = 0.04, respectively). While augmentation index increased in the CHD group (28.0 +/- 9.4 to 31.0 +/- 10.7%, p = 0.02), pulse wave velocity did not change. Subendocardial viability ratio and ejection duration improved in the NHD group (from 135 +/- 28 to 143 +/- 25%, p = 0.01 and from 294 +/- 34 ms to 281 +/- 34 ms, p = 0.003, respectively), accompanied by regression of left ventricular mass index. In multiple stepwise linear regression analyses, NHD was associated with improvements in augmentation index, ejection duration and subendocardial viability ratio. Conclusions: These data indicate that arterial stiffness is ameliorated by implementation of longer hemodialysis sessions. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe The effects of two different blood pressure control strategies on cardiac structures and functions in hemodialysis patients(Elsevier Science Inc, 2007) Kaylkcioglu, Meral; Tumuklu, Murat; Asci, Gulay; Ozdogan, Oner; Toz, Huseyin; Bozkurt, Devrim; Kose, Timur; Duman, Soner; Ozkahya, Mehmet; Can, Levent H.; Basci, Ali; Ok, ErcanÖğe The effects of two different blood pressure control strategies on cardiac structures and functions in hemodialysis patients(Oxford Univ Press, 2007) Kayikcioglu, Meral; Tumuklu, Murat; Asci, Gulay; Toz, Huseyin; Ozdogan, Oner; Bozkurt, Devrim; Kos, Timur; Duman, Soner; Ozkahya, Mehmet; Can, Levent; Basci, Ali; Ok, ErcanÖğe Factors Related to Pulse Wave Velocity and Augmentation Index in Chronic Hemodialysis Patients(Informa Healthcare, 2011) Celik, Gulperi; Demirci, Meltem Sezis; Tumuklu, Murat; Asci, Gulay; Sipahi, Savas; Toz, Huseyin; Basci, Ali; Ok, ErcanBackground: Augmentation index (AIx) and pulse wave velocity (PWV) are early markers of atherosclerotic vascular changes and also have been shown to be predictive of cardiovascular disease and total mortality. The aim of our study was to evaluate the relationship between PWV and AIx-HR75, which is the corrected form of AIx according to a heart rate of 75 beats/min, echocardiographic parameters and biochemical parameters in chronic hemodialysis (HD) patients. Subjects and methods: AIx-HR75 and PWV were measured in 556 HD patients by applanation tonometry using the SphygmoCor device. Results: The mean PWV and AIx-HR75 values of the study group were 10.2 +/- 2.4 and 28.4 +/- 10.2 m/s. A positive correlation was found between PWV and AIx-HR75 (r = 0.214, p = 0.000). AIx-HR75 correlated with age (r = 0.093, p = 0.028), body surface area (BSA) (r = -0.194, p = 0.000), mean arterial pressure (MAP) (r = 0.335, p = 0.000), pulse pressure (PP) (r = 0.212, p = 0.000), cardiothoracic index (r = 0.155, p = 0.016), and presence of left ventricular hypertrophy (r = 0.152, p = 0.001). PWV correlated with MAP (r = 0.208, p = 0.000), PP (r = 0.098, r = 0.021), left ventricular mass (r = 0.105, p = 0.023), and predialysis sodium level (r = -0.105, p = 0.023). In the multivariate analyses, PWV was associated with MAP (t = 3.78, p = 0.000), presence of diabetes (t = 3.20, p = 0.001), and predialysis sodium level (t = -2.06, p = 0.040), and AIx-HR75 was associated with age (t = 2.48, p = 0.014), female sex (t = 3.98, p = 0.000), BSA (t = -2.15, p = 0.033), and MAP (t = 7.02, p = 0.000). Conclusion: There is a strong association between MAP and arterial stiffness parameters in HD patients. We feel that efficient control of blood pressure could lead to reduced arterial stiffness in HD patients.Öğe The Impact of Membrane Permeability and Dialysate Purity on Cardiovascular Outcomes(Amer Soc Nephrology, 2013) Asci, Gulay; Toz, Huseyin; Ozkahya, Mehmet; Duman, Soner; Demirci, Meltem Sezis; Cirit, Mustafa; Sipahi, Savas; Dheir, Hamad; Bozkurt, Devrim; Kircelli, Fatih; Ok, Ebru Sevinc; Erten, Sinan; Ertilav, Muhittin; Kose, Timur; Basci, Ali; Raimann, Jochen G.; Levin, Nathan W.; Ok, ErcanThe effects of high-flux dialysis and ultrapure dialysate on survival of hemodialysis patients are incompletely understood. We conducted a randomized controlled trial to investigate the effects of both membrane permeability and dialysate purity on cardiovascular outcomes. We randomly assigned 704 patients on three times per week hemodialysis to either high- or low-flux dialyzers and either ultrapure or standard dialysate using a two-by-two factorial design. The primary outcome was a composite of fatal and nonfatal cardiovascular events during a minimum 3 years follow-up. We did not detect statistically significant differences in the primary outcome between high- and low-flux (HR=0.73, 95% CI=0.49 to 1.08, P=0.12) and between ultrapure and standard dialysate (HR=0.90, 95% CI=0.61 to 1.32, P=0.60). Posthoc analyses suggested that cardiovascular event-free survival was significantly better in the high-flux group compared with the low-flux group for the subgroup with arteriovenous fistulas, which constituted 82% of the study population (adjusted HR=0.61, 95% CI=0.38 to 0.97, P=0.03). Furthermore, high-flux dialysis associated with a lower risk for cardiovascular events among diabetic subjects (adjusted HR=0.49, 95% CI=0.25 to 0.94, P=0.03), and ultrapure dialysate associated with a lower risk for cardiovascular events among subjects with more than 3 years of dialysis (adjusted H R=0.55, 95% CI=0.31 to 0.97, P=0.04). In conclusion, this trial did not detect a difference in cardiovascular event-free survival between flux and dialysate groups. Posthoc analyses suggest that high-flux hemodialysis may benefit patients with an arteriovenous fistula and patients with diabetes and that ultrapure dialysate may benefit patients with longer dialysis vintage.Öğe Increased arterial stiffness in patients with nephrotic syndrome(Dustri-Verlag Dr Karl Feistle, 2013) Gungor, Ozkan; Demirci, Meltem Sezis; Kircelli, Fatih; Tatar, Erhan; Sipahi, Savas; Hur, Ender; Sen, Sait; Toz, Huseyin; Basci, Ali; Ok, ErcanIntroduction: Nephrotic syndrome (NS) and arterial stiffness (AS) have each been linked with increased risk for cardiovascular diseases. However, there is no data in the literature up-to-date on AS in adult patients with NS. Thus, in this study, we aimed to evaluate the potential associations between AS, volume and nutritional status in patients with NS in comparison to a healthy control group. Methods: 34 adult patients with newly diagnosed but untreated NS and 34 healthy controls were studied. AS was assessed by carotid-femoral PWV (cf-PWV) and body composition, nutritional status by multi-frequency bioelectric impedance analysis (BIA). Results: Mean age was 44.6 +/- 18.7 years (18 - 72). Mean cf-PWV was 8.3 +/- 2.5 m/s in patients with NS and 6.7 +/- 1.1 m/s in controls (p = 0.002). In univariate analysis, cf-PWV and positively correlated with age, systolic blood pressure, mean arterial pressure (MAP), pulse pressure, body mass index, body fat ratio, waisthip ratio, creatinine, uric acid and negatively with creatinine clearance. In linear regression analysis, only age and MAP predicted arterial stifffiess. Total body fluid, extracellular water (ECW), ECW/Height, ECW/body surface area and third space volumes were higher in patients with NS. Conclusion: Patients with NS have increased AS and are more hypervolemic compared to the healthy subjects.Öğe Increased arterial stiffness in patients with nephrotic syndrome(Dustri-Verlag Dr Karl Feistle, 2013) Gungor, Ozkan; Demirci, Meltem Sezis; Kircelli, Fatih; Tatar, Erhan; Sipahi, Savas; Hur, Ender; Sen, Sait; Toz, Huseyin; Basci, Ali; Ok, ErcanIntroduction: Nephrotic syndrome (NS) and arterial stiffness (AS) have each been linked with increased risk for cardiovascular diseases. However, there is no data in the literature up-to-date on AS in adult patients with NS. Thus, in this study, we aimed to evaluate the potential associations between AS, volume and nutritional status in patients with NS in comparison to a healthy control group. Methods: 34 adult patients with newly diagnosed but untreated NS and 34 healthy controls were studied. AS was assessed by carotid-femoral PWV (cf-PWV) and body composition, nutritional status by multi-frequency bioelectric impedance analysis (BIA). Results: Mean age was 44.6 +/- 18.7 years (18 - 72). Mean cf-PWV was 8.3 +/- 2.5 m/s in patients with NS and 6.7 +/- 1.1 m/s in controls (p = 0.002). In univariate analysis, cf-PWV and positively correlated with age, systolic blood pressure, mean arterial pressure (MAP), pulse pressure, body mass index, body fat ratio, waisthip ratio, creatinine, uric acid and negatively with creatinine clearance. In linear regression analysis, only age and MAP predicted arterial stifffiess. Total body fluid, extracellular water (ECW), ECW/Height, ECW/body surface area and third space volumes were higher in patients with NS. Conclusion: Patients with NS have increased AS and are more hypervolemic compared to the healthy subjects.Öğe Inflammatory bowel disease presenting with nephrotic syndrome and cholestasis(Turkish Soc Gastroenterology, 2013) Gungor, Ozkan; Sarsik, Banu; Tatar, Erhan; Akarca, Ulus Salih; Tekesin, Oktay; Sezak, Murat; Basci, AliÖğe THE INFLUENCE OF DIALYSATE CALCIUM ON PROGRESSION OF ARTERIAL STIFFNESS IN PERITONEAL DIALYSIS PATIENTS(Multimed Inc, 2009) Demirci, Meltem Sezis; Ozkahya, Mehmet; Asci, Gulay; Sevinc, Ebru; Yilmaz, Mumtaz; Demirci, Cenk; Toz, Huseyin; Basci, Ali; Ok, ErcanBackground: One of the origins of cardiovascular disease in dialysis patients is arterial stiffness. The aim of our study was to assess the relationship between the calcium content of peritoneal dialysis (PD) solution and arterial stiffness. Patients and Methods: We enrolled into the study 49 PD patients who had been treated with the same PD solution for the preceding 6 months. The calcium content of the PD solution was 1.25 mmol/L in 34 patients (low-Ca group) and 1.75 mmol/L in 15 patients (high-Ca group). Study patients were followed for 6 months on the same PD prescription. Arterial stiffness was assessed by measurement of augmentation index (AI) and brachial pulse wave velocity (PWV) at baseline and at month 6 (SphygmoCor: Atcor Medical, West Ryde, NSW, Australia). Demographic data were recorded from patient charts. Results: Mean age of the whole group was 51 +/- 11 years, prevalence of diabetes was 14%, duration of PD was 43 +/- 30 months, percentage of women was 45%, and percentage of patients using a cycler was 33%. We observed no differences between groups with regard to those variables or creatinine clearance, residual renal function, Ca, phosphorus, parathormone, C-reactive protein, lipid parameters, and use of phosphate binder with or without Ca content. Mean arterial pressure was higher in the high-Ca group, but the difference was not statistically significant (100 +/- 22 mmHg vs 88 +/- 18 mmHg, p = 0.06). At baseline, AI was significantly higher in the high-Ca group than in the low-Ca group (27% +/- 10% vs 21% +/- 9%, p < 0.05). Measurements of PWV were not different between the groups (8.4 +/- 1.1 m/s vs 8.5 +/- 1.7 m/s). Measurement of arterial stiffness parameters at month 6 revealed that PWV had increased in the high- Ca group (to 9.6 +/- 2.3 m/s from 8.4 +/- 1.1 m/s, p < 0.05), but had not changed in the low-Ca group (to 8.2 +/- 1.9 m/s from 8.5 +/- 1.7 m/s). The AI did not change in either group. Conclusions: These data suggest that Ca exposure through PD solution plays a role in the progression of arterial stiffness, which may be related to increased vascular calcification.Öğe Is it necessary to check outcomes to improve quality of care? The example of anemia management(Wichtig Editore, 2008) Di Benedetto, Attilio; Richards, Nick; Marcelli, Daniele; Basci, Ali; Cesare, Salvatore; Ponce, Pedro; Scatizzi, Laura; Marotta, PaoloThe aim of this study was to verify the importance of continuously monitoring the level of adherence to the anemia guideline recommendations in order to improve not only quality of care but also patient safety. Data presented in this investigation were gained through the FME database EuCliD (R) which contains the clinical data of over 24,000 prevalent patients under treatment at the time of the analysis in 344 dialysis centres in 15 countries. Patient data from 4 countries (United Kingdom, Turkey, Italy, Portugal) was used for this study. The parameter selected was anemia control. The level of hemoglobin (Hb) was considered as the quality indicator for anemia, the target being an Hb level > 11 g/dL, for UK centres the target was > 10 g/dL. All new patients commencing hemodialysis between October 2003 and September 30, 2004 with the previous follow-up of less than one month and without previous blood transfusion were considered. A total of 902 patients were enrolled. The study showed that 4 to 6% of the Italian, Portuguese and British patients treated in FME clinics received a blood transfusion during the first year of follow-up. This is consistent with reports by USRDS that only 3.3% of ESRD patients received at least 1 transfusion per quarter in 1992 after erythropoietin became available and was prescribed to 88% of patients. About 18% Turkish patients, required blood transfusions during the first year of follow-up on hemodialysis, which is more comparable with USRDS data reported in 1989, when 16% of patients needed at least 1 transfusion quarterly. In conclusion, the practice of blood transfusion for hemodialysis patients is still frequent especially in elderly patients.Öğe The link between cardiovascular and bone disease in hemodialysis patients(Oxford Univ Press, 2007) Asci, Gulay; Ozkahya, Mehmet; Duman, Soner; Toz, Huseyin; Savas, Recep; Kayikcioglu, Meral; Celik, Gulperi; Ozbek, Sureyya; Basci, Ali; Monier-Faugere, Marie Claude; Malluche, Hartmut H.; Ok, ErcanÖğe THE LINK BETWEEN KIDNEY VOLUME DETERMINED BY TOMOGRAPHY AND KIDNEY HISTOLOGY IN RENAL TRANSPLANT DONORS(Wiley-Blackwell, 2013) Tatar, Erhan; Sen, Sait; Harman, Mustafa; Kircelli, Fatih; Gungor, Ozkan; Sarsik, Banu; Hoscoskun, Cuneyt; Basci, Ali; Toz, HuseyinÖğe Long-term survival rates in haemodialysis patients treated with strict volume control(Oxford Univ Press, 2006) Ozkahya, Mehmet; Ok, Ercan; Toz, Huseyin; Asci, Gulay; Duman, Soner; Basci, Ali; Kose, Timur; Dorhout Mees, E. J.Methods. We analysed the survival of 218 patients (132 male, 86 female, age 48 +/- 15 years) who were treated in our dialysis units since we adopted the strategy of strict volume control without antihypertensive drugs. The mean observation period was 47 +/- 34 (6-140) months. Follow-up was ended because of death (57 patients), transfer to another center (35 patients), continous ambulatory peritoneal dialysis (CAPD) (15 patients) or transplantation (23 patients), while 88 were still under our treatment at the time of writing. Results. Blood pressure (BP) decreased from a mean of 150 +/- 31/89 +/- 16 at the start to 121 +/- 14/75 +/- 8 mmHg at the end of observation (P < 0.001). Only nine patients needed a drug (enalapril) to reach this goal. Cardiothoracic index (CTI) dropped from 0.50 +/- 0.06 to 0.46 +/- 0.05 (P < 0.001). Interdialytic weight gain decreased from 1440 +/- 360 to 930 +/- 240 g/day (P < 0.001). Mortality rate was 68, 2 per 1000 patient-years, better than in most published series. There was a striking influence of age, but also of CTI and systolic BP on survival rate. Patients with CTI >= 0.48 showed mortality 3.8 times higher than CTI < 0.48 (log rank P < 0.001). Consequently, the mean CTI of the deceased patients was much higher (0.50) than the average of the group (0.46) while their mean BP (123 +/- 16/75 +/- 9 mmHg) was not significantly different from the other patients. We found no increased mortality at low-normal pressure levels (systolic BP between 100 and 130 mmHg), but mortality was increased in small groups of patients whose pressures were lower or higher than these values. Thus, the curve, relating mortality to blood pressure was shifted markedly to the left. Conclusions. These results strongly suggest that the strategy of 'volume control', also when applied with conventional dialysis times, normalizes BP and increases survival of dialysis patients. Cardiomegaly, as evidenced on the chest X-ray despite normal BP, had a strong negative influence on survival. The large majority of the patients had low-normal BP after long periods of treatment and showed the lowest mortality, favouring the view that target BP should be lower than advised by most authors.Öğe Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study(Oxford Univ Press, 2013) Ok, Ercan; Asci, Gulay; Toz, Huseyin; Ok, Ebru Sevinc; Kircelli, Fatih; Yilmaz, Mumtaz; Hur, Ender; Demirci, Meltem Sezis; Demirci, Cenk; Duman, Soner; Basci, Ali; Adam, Siddig Momin; Isik, Ismet Onder; Zengin, Murat; Suleymanlar, Gultekin; Yilmaz, Mehmet Emin; Ozkahya, MehmetBackground. Online haemodiafiltration (OL-HDF) is considered to confer clinical benefits over haemodialysis (HD) in terms of solute removal in patients undergoing maintenance HD. The aim of this study was to compare postdilution OL-HDF and high-flux HD in terms of morbidity and mortality. Methods. In this prospective, randomized, controlled trial, we enrolled 782 patients undergoing thrice-weekly HD and randomly assigned them in a 1:1 ratio to either postdilution OL-HDF or high-flux HD. The mean age of patients was 56.5 +/- 13.9 years, time on HD 57.9 +/- 44.6 months with a diabetes incidence of 34.7%. The follow-up period was 2 years, with the mean follow-up of 22.7 +/- 10.9 months. The primary outcome was a composite of death from any cause and nonfatal cardiovascular events. The major secondary outcomes were cardiovascular and overall mortality, intradialytic complications, hospitalization rate, changes in several laboratory parameters and medications used. Results. The filtration volume in OL-HDF was 17.2 +/- 1.3 L. Primary outcome was not different between the groups (event-free survival of 77.6% in OL-HDF versus 74.8% in the high-flux group, P = 0.28), as well as cardiovascular and overall survival, hospitalization rate and number of hypotensive episodes. In a post hoc analysis, the subgroup of OL-HDF patients treated with a median substitution volume >17.4 L per session (high-efficiency OL-HDF, n = 195) had better cardiovascular (P = 0.002) and overall survival (P = 0.03) compared with the high-flux BD group. In adjusted Cox-regression analysis, treatment with high-efficiency OL-BDF was associated with a 46% risk reduction for overall mortality {RR = 0.54 [95% confidence interval (95% CI) 0.31-0.93], P = 0.02} and a 71% risk reduction for cardiovascular mortality [RR = 0.29 (95% CI 0.12-0.65), P = 0.003] compared with high-flux BD. Conclusions. The composite of all-cause mortality and nonfatal cardiovascular event rate was not different in the OL-HDF and in the high-flux BD groups. In a post hoc analysis, OL-HDF treatment with substitution volumes over 17.4 L was associated with better cardiovascular and overall survival.
