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- Alvestrand, A, et al.
(författare)
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Left ventricular hypertrophy in incident dialysis patients randomized to treatment with hemofiltration or hemodialysis: results from the ProFil study
- 2011
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 32:1, s. 21-29
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Tidskriftsartikel (refereegranskat)abstract
- <i>Introduction:</i> Left ventricular hypertrophy (LVH) is present in a majority of hemodialysis (HD) patients and is among the strongest risk factors for cardiovascular events and mortality. Hemofiltration (HF), a purely convective dialysis treatment, has been associated with enhanced hemodynamic stability compared with HD, possibly as a result of a more physiologic removal of fluid and solutes. <i>Methods:</i> In a randomized controlled study conducted at ten dialysis centers in Sweden and Denmark, incident patients (HD <3 months) without clinical signs or history of cardiovascular disease were randomized to treatment with either online, predilution HF or low-flux HD. The primary endpoint was change in left ventricular mass index (LVMI), as measured by two-dimensional M-mode and Doppler echocardiography. <i>Results:</i> The analyses included 34 patients (18 HF, 16 HD) followed for up to 2 years. At baseline, 65% of the patients had LVH, but LVMI did not differ between the study groups. In the HF group, LVMI decreased by 22 ± 48 g/m<sup>2</sup> during a mean treatment time of 19 ± 7 months, while in the HD group the decrease was 15 ± 57 g/m<sup>2</sup> during 16 ± 7 months. As analyzed by MANOVA (mixed model), the difference in LVMI over the whole period was statistically significant (p = 0.03) with a more favorable outcome in HF. Blood pressure and other study variables did not differ between the groups, but at baseline and throughout the study, HF patients required heavier antihypertensive treatment. <i>Conclusions:</i> In incident dialysis patients, long-term predilution HF, a purely convective dialysis treatment, is associated with a significantly more favorable development of LVMI compared with regular low-flux HD. Considering the predictive strength of LVMI as a risk factor, the quantitative difference between the treatments is of clinical importance.
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