[Cardionephrology: past, present and future].

In 1987, the first Kidney-Heart meeting was held in Assisi, Italy and in 1991 the term Cardionephrology was coined in medical practice. Since then, nephrologists and cardiologists realized the utility of a tight cooperation among them and organized an agenda of scientific meetings which take place every two years within European countries. The cooperation was strengthened by daily observation which shows renal replacement therapy had solved many problems but imposed or added new disorders to cardiovascular system.

Significance of interdialytic weight gain versus chronic volume overload: consensus opinion.

Predialysis volume overload is the sum of interdialytic weight gain (IDWG) and residual postdialysis volume overload. It results mostly from failure to achieve an adequate volume status at the end of the dialysis session. Recent developments in bioimpedance spectroscopy and possibly relative plasma volume monitoring permit noninvasive volume status assessment in hemodialysis patients.

Treatment frequency and efficiency in hemodiafiltration.

Background: One of the main objectives of dialysis is uremic retention product elimination. Efficiency of dialysis modalities varies both regarding the range of solutes removed and the extent of such removal. We analyzed plasma (or blood) concentrations of marker solutes in intermittent treatment schedules using hemodiafiltration (HDF).

Acetate-free biofiltration reduces intradialytic hypotension: a European multicenter randomized controlled trial.

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.

Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients.

Background: Geographical differences in disease prevalence and mortality have been described in the general population and in chronic kidney disease patients in Europe. In this secondary analysis of the Membrane Permeability Outcome (MPO) study, we addressed differences in patient and treatment patterns, and whether these affect patient outcomes.

Methods: Participating countries were grouped according to geographical location; thus study centers in France, Greece, Italy, Portugal and Spain were allocated to southern Europe (n=499), and those in all other countries (Belgium, Germany, Poland and Sweden) to northern Europe (n=148).

Importance of normohydration for the long-term survival of haemodialysis patients.

Background: Fluid overload and hypertension are among the most important risk factors for haemodialysis (HD) patients. The aim of this study was to analyse the impact of fluid overload for the survival of HD patients by using a selected reference population from Tassin.

Methods: A positively selected HD population (n = 50) from Tassin (Lyon-France) was used as a reference for fluid status and all-cause mortality.

Therapeutic equivalence of epoetin zeta and alfa, administered subcutaneously, for maintenance treatment of renal anemia.

Introduction: The primary objective of the trial was to prove the therapeutic equivalence of epoetin zeta to epoetin alfa when administered subcutaneously for maintaining target hemoglobin (Hb) in patients with renal anemia on chronic hemodialysis. Additional information was provided on the safety and tolerability of epoetin zeta with particular focus on the formation of anti-erythropoietin antibodies.

Methods: A total of 462 patients were randomized to either epoetin zeta or alfa for 28 weeks after an open period of dose adjustment of 12-16 weeks with only epoetin zeta.

Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy.

Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we determined incidence, prevalence, and outcomes among hemodialysis patients with atrial fibrillation. Cox proportional hazards models, to identify associations with newly diagnosed atrial fibrillation and clinical outcomes, were stratified by country and study phase and adjusted for descriptive characteristics and comorbidities. Of 17,513 randomly sampled patients, 2188 had preexisting atrial fibrillation, with wide variation in prevalence across countries.

The mortality risk of overhydration in haemodialysis patients.

Background: While cardiovascular events remain the primary form of mortality in haemodialysis (HD) patients, few centres are aware of the impact of the hydration status (HS). The aim of this study was to investigate how the magnitude of the prevailing overhydration influences long-term survival.

Methods: We measured the hydration status in 269 prevalent HD patients (28% diabetics, dialysis vintage = 41.

Effect of membrane permeability on survival of hemodialysis patients.

The effect of high-flux hemodialysis membranes on patient survival has not been unequivocally determined. In this prospective, randomized clinical trial, we enrolled 738 incident hemodialysis patients, stratified them by serum albumin < or = 4 and >4 g/dl, and assigned them to either low-flux or high-flux membranes. We followed patients for 3 to 7.

Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload.

Background: Hypertension and fluid overload (FO) are well-recognized problems in the chronic kidney disease (CKD) population. While the prevalence of hypertension is well documented, little is known about the severity of FO in this population.

Methods: A new bioimpedance spectroscopy device (BCM-Body Composition Monitor) was selected that allows quantitative determination of the deviation in hydration status from normal ranges (DeltaHS).

Whole-body spectroscopy (BCM) in the assessment of normovolemia in hemodialysis patients.

Whole-body impedance spectroscopy (BCM) has been validated by comparing isotope dilution methods for precisely measuring body volume compartments. Clinical assessment as well as comparison to other methods shows that BCM predicts a reliable individual dialysis target weight in kilograms, which corresponds to a physiological (normal) extracellular volume. BCM is helpful in the management of volume status and arterial hypertension in hemodialysis patients as well as in patients with chronic kidney disease.

Comparison of the therapeutic effects of epoetin zeta to epoetin alfa in the maintenance phase of renal anaemia treatment.

Objective: To evaluate the therapeutic efficacy and safety of epoetin zeta, compared with epoetin alfa, in maintaining target haemoglobin (Hb) concentrations in patients with anaemia and chronic kidney disease (CKD) maintained on haemodialysis.

Methods: Patients received epoetin zeta or epoetin alfa intravenously, 1-3 times/week for 12 weeks, then the alternative treatment for 12 weeks, in this double-blind, crossover, phase III trial. Eligible patients were 18-75 years old with CKD stage 5 maintained on haemodialysis.

The MPO Study: just a European HEMO Study or something very different?

Although results from observational and epidemiological studies suggested a survival benefit associated with high-flux hemodialysis, conclusive evidence from prospective randomized clinical trials has been lacking. Both the HEMO Study in the USA and the Membrane Permeability Outcome Study (MPO Study) in Europe are randomized studies investigating the effect of high- and low-flux hemodialysis on patient outcomes, even though there were some significant differences in the design of the two studies. An earlier randomized clinical trial could not show differences on patient survival between patient groups being treated with membranes of different material and permeability, but this trial was not designed specifically to examine this particular endpoint.

Low- (classical) and high-efficiency haemodiafiltration.

The distinction between high-efficiency haemodiafiltration (HDF), usually applied with online preparation of substitution fluid, and 'classic' low-efficiency HDF (using less than 15 litres of substitution fluid) makes sense since the magnitude of convection (expressed by substitution volume) is important for the claimed benefits of HDF. Many experimental and observational data support the notion that in comparison to conventional low-flux haemodialysis, high-efficiency HDF might have many clinical advantages and might prolong life. Randomized prospective trials, such as a current Dutch trial, are overdue to prove these hypotheses.

Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS).

Background: Information about residual renal function (RRF) and outcomes associated with practices of diuretic use in patients with end-stage renal disease is not available worldwide.

Methods: Diuretic use was investigated in 16,420 hemodialysis patients from the Dialysis Outcomes and Practice Patterns Study, a prospective observational study of hemodialysis patients selected from nationally representative facilities on 3 continents. Logistic regressions were used to investigate associations between diuretic use and patient characteristics.

Thoracic impedance measurements during orthostatic change test and during hemodialysis in hemodialyzed patients.

Measurements were performed before and after hemodialysis (HD) in the supine and upright positions (orthostatic change test) and during HD session every 30 minutes in recumbent position on 11 HD patients. Two hydration states were compared: hyperhydration and normal hydration. Each patient served as his own control.

Dialysis Outcomes and Practice Patterns Study (DOPPS) data on medications in hemodialysis patients.

Background: Medications affect many measures of hemodialysis patients' well-being.

Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) has evaluated the use of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins), analgesics, antidepressants, and multivitamins. Additionally, DOPPS has reported on the associations between vascular access outcomes and related medications.

Infective tricuspid valve endocarditis with septic pulmonary emboli due to puncture of an endogenous arteriovenous fistula in a chronic hemodialysis patient.

Background: Patients on chronic hemodialysis are at high risk for infectious endocarditis due to prosthetic access devices such as cuffed venous catheters and polytetrafluoroethylene grafts. Right-sided endocarditis without any predisposing factors is rare in dialysed patients.

Case Report: A 42-year-old man with chronic renal failure was referred to hospital due to febrile temperatures.

A new technique for establishing dry weight in hemodialysis patients via whole body bioimpedance.

Background: Quantitative techniques are necessary to achieve dry weight (DW) in patients with kidney failure. Bioimpedance spectroscopy (BIS) is a non-invasive method that determines the volume of body fluid compartments. The current work evaluates the use of BIS data in hemodialysis patients for the prediction of DW.