FP452EVOLUTION OF N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE IN PATIENTS UNDERGOING HIGH EFFICIENCY ON-LINE HEMODIAFILTRATION VERSUS CONVENTIONAL LOW-FLUX HEMODIALYSIS
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Recent large randomized clinical trials suggested that on-line hemodiafiltration (HDF) had a beneficial effect on survival compared to conventional low-flux hemodialysis (HD), mostly due to a reduction in fatal cardiac events. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been linked to the risk of cardiovascular and all-cause mortality in the dialysis population. With its 8400 Da molecular weight, NT-proBNP is cleared by HDF during treatment. However, little is still known as to long-term evolution of pre-dialysis NT-proBNP according to dialysis modality. The aim of this study was to determine the effect of HDF vs HD on NT-proBNP at 1-year follow-up. METHODS: Patients were randomized from 2007 to 2013 to HD or HDF in accordance with the CONvective TRAnsport STudy (CONTRAST) protocol initially (until 2010) and subsequently as part of the local cohort (2010-2013). Patients with a myocardial infarction within 2 months of randomization were excluded. NT-proBNP were obtained before dialysis session and analyzed at baseline and at 1-year follow-up. Comparisons of the evolution of NT-proBNP between groups were performed with the Mann-Whitney test. RESULTS: A total of 53 HDF patients and 58 HD patients were included. Patients on HDF and HD were comparable both for clinical characteristics and for dialysis treatment parameters. Prior to randomization, all patients had been previously treated with conventional hemodialysis. At baseline, median NT-proBNP value was 3490 ng/L (IQR 1716—12 620) in the HDF group vs. 5267 (2122—17 127) in the HD group (p=0.272). Dialysis was provided according to randomization with comparable dialysis session time and frequency. HDF sessions were performed in post-dilution mode and convection volume was 28.6 L (IQR 26.2-31.4) in the HDF group. At 1-year follow-up, median NT-proBNP remained stable at 2584 ng/L (IQR 1375—8406) in the HDF group (p=0.566 vs. baseline), but had increased to 9962 (2823-30 545) in the HD group (p= 0.001 vs. baseline, p=0.001 vs. HDF). The median variation (delta) in NT-proBNP values was +135 ng/L (IQR -1727—1155) in the HDF group or +7% (-53%-+51%) vs. +2009 ng/L (-95-+12 043) or +33% (-7%-162%) in the HD group (p=0.003 between groups). CONCLUSIONS: Treatment with high-efficiency HDF is associated with stability in NT-proBNP values whereas low-flux HD is associated with an increase in NT-proBNP levels at 1-year follow-up. Future studies are needed to establish whether those variations in NT-proBNP values are a consequence of higher filtration, or rather a protective cardiac effect of HDF, or a mix of both, and if they are related to better clinical outcomes in HDF patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".