Highlights from EDTA 2011 in Prague
EDTA 2011 - Fresenius Medical Care Lunch Symposium
This year’s ERA-EDTA (European Renal Association – European Dialysis and Transplant Association) took place in Prague, from June 23rd – 26th, 2011. As every year, Fresenius Medical Care organized a lunch symposium titled “Transforming Research into Daily Practice – Tackling the Cardiovascular Challenge in Haemodialysis”.
The Chairmen Dr. A. Ferreira (Portugal) and Dr. A. Martin-Malo (Spain) could welcome more than 1000 nephrologists from all over the world to this symposium.
The symposium was opened up by Professor D. Cusi from Milan, Italy. His talk dealt with the challenge of cardiovascular morbidity and mortality in haemodialysis patients. Significantly more haemodialysis patients suffer from cardiovascular disease than patients of the same age from the general population. Fluid and electrolyte disturbances, bone and mineral disease and inflammation on top of the conventional risk factors seen in the general population are responsible for the high death toll.
Dr. P. Blankestijn (Utrecht, The Netherlands), one of the principal investigators of the international Convective Transport Study (CONTRAST), stressed the importance of convective therapy, especially Online-HDF. Combining diffusive and convective transport results in an improved ß2-microglobulin removal, calcium/phosphate management and also in better intra-dialytic haemodynamic stability. This leads to an improvement of meaningful clinical outcome variables, such as all-cause mortality, cardiovascular morbidity and/or quality of life.
The symposium was continued by Professor E. Ok (Izmir, Turkey), responsible for several recent major clinical trials in HD patients. Together with various dialysis clinics within the Fresenius Medical Care network, important results have been compiled, which will help to improve outcome in HD treatment.
The Long Dialysis Study compared 8-hour versus 4-hour haemodialysis over one year in 494 prevalent HD patients. The primary endpoint was overall mortality. Long dialysis treatment was associated with a 72% risk reduction for overall mortality compared to 4h conventional HD, p = 0.02.
The prospective, randomized, controlled EGE(University) study examined the impact of membrane flux and dialysate quality on cardiovascular outcomes. 704 HD patients were assigned to either high-flux or low-flux dialysers and either ultrapure dialysate (UD) or standard dialysate (SD) groups. The combination of high-flux and UD resulted in a greater survival in comparison to the three other investigated groups.
The concluding presentation was held by Dr. Ch. Chazot (Tassin, France). He emphasized the importance of sodium balance in chronic kidney disease: fluid and salt overload causes cardiovascular remodelling with a high prevalence of hypertension and left-ventricular hypertrophy. He could show by using the multifrequency bioimpedance device BCM-Body Composition Monitor that HD patients presenting with overhydration had a significantly higher risk of mortality compared to patients achieving target dry weight.
Karla Bröhl
