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        "titulo" => "Rean&#225;lisis del estudio ESHOL&#58; mortalidad por todas las causas considerando riesgos de competici&#243;n y tiempo-dependientes para trasplante renal"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves for 36-month survival in competitive risks cumulative incidence of death &#40;Gray&#39;s test&#44; <span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; HD denotes hemodialysis&#44; and OL-HDF&#44; on-line hemodiafiltration&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The &#8220;On-Line Hemodiafiltration Survival Study&#8221; &#91;<span class="elsevierStyleItalic">Estudio de Supervivencia de Hemodiafiltraci&#243;n On-Line&#8217;</span> &#40;ESHOL&#41;&#93;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> showed that high-efficiency post-dilution OL-HDF reduces all-cause mortality versus conventional hemodialysis &#40;HD&#41; in prevalent chronic dialysis patients&#46; The inferential analysis of the main variable&#44; time to occurrence of any event&#44; defined as all-cause mortality &#40;overall survival&#41;&#44; was estimated from the unadjusted Cox model with no imputation by means of the log-rank test for the between-treatment comparison and hazard ratios &#40;HR&#41; with their 95&#37; confidence intervals&#46; The study provided a detailed description of the time and causes of censoring to rule out any potential biases&#46; However&#44; during the observation period&#44; 355 patients prematurely finished the study and&#44; according to the study design&#44; all these patients were censored at the time of premature termination&#46; Most studies conducted in hemodialysis patients &#40;the Hemodialysis &#40;HEMO&#41; study&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> the Membrane Permeability Outcome &#40;MPO&#41; study&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> the Turkish HDF study<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a>&#41; have been performed with this method&#44; given that a high percentage of patients could be excluded mainly due to renal transplantation&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In randomized clinical trials &#40;RCT&#41;&#44; it is recommended that data be analyzed by an intention-to-treat &#40;ITT&#41; analysis&#44; which compares outcomes according to the initial random allocation&#44; regardless of which intervention the patients actually received&#46; ITT is recommended as the method of choice for analysis in trials investigating the superiority of an intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#8211;7</span></a> Among studies comparing OL-HDF with HD&#44; only the CONTRAST study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> used ITT to analyze the primary endpoint&#46; This kind of analysis avoids various misleading artifacts that can arise in intervention research&#44; such non-random attrition of participants from the study&#46; Importantly&#44; a non-ITT analysis may lose the benefits of randomization&#44; as the groups may no longer be balanced with regard to factors influencing the outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9&#44;10</span></a> In the ESHOL study&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> 164 patients were censored in the HD arm and 191 patients in the OL-HDF arm&#46; As expected&#44; renal transplantation was the main cause of censoring &#40;79 in the HD arm and 101 in the OL-HDF arm&#41;&#46; In survival analysis conducted to analyze the risk of death in dialysis patients&#44; renal transplantation is a well-known competing risk because&#44; after transplantation&#44; patients will no longer be on dialysis and&#44; therefore&#44; will not be at risk of dying on dialysis&#46; In this setting&#44; the competing event&#44; i&#46;e&#46; kidney transplantation&#44; hinders the occurrence of the event of interest&#46; Different approaches have been proposed to overcome this difficulty&#44; but the best option is to conduct a full ITT analysis after completion of follow-up for censored observations for any reason in order to evaluate the risk of death for censored observations from both arms of the trial&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to investigate the outcome of patients who discontinued the ESHOL study and to re-analyze survival data by using the ITT population with a 3-year follow-up&#46; We also performed a sensitivity analysis using the ITT population&#46; Finally&#44; we analyzed our data&#44; considering renal transplantation as a competing event to patient death&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">General methods and patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">The design and methods of the ESHOL study have previously been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> Briefly&#44; the ESHOL study was a prospective&#44; randomized&#44; open-label clinical trial in patients with end-stage renal disease under hemodialysis in Catalonia &#40;Spain&#41;&#46; The registered protocol number is <a href="ctgov:NCT00694031">NCT00694031</a>&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The primary objective was to assess the effect of postdilution OL-HDF compared with hemodialysis on all-cause mortality&#46; The primary outcome variable was the time to the occurrence of death from any cause&#46; Key secondary outcomes were cardiovascular mortality and other causes of mortality&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study population has been previously described&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;11</span></a> Essentially&#44; the inclusion criteria consisted of patients older than 18 years with end-stage renal disease receiving thrice-weekly standard hemodialysis for more than 3 months&#46; Exclusion criteria were as follows&#58; active systemic diseases&#44; liver cirrhosis&#44; malignancy&#44; immunosuppressive therapy&#44; inadequate dialysis dose &#40;single pool Kt&#47;V<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#41;&#44; single-needle dialysis and the use of temporary non-tunneled catheters&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Randomization and dialysis treatment parameters</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were randomized 1&#58;1 to continue on thrice weekly hemodialysis or to start OL-HDF 3 times a week&#46; The length of the recruitment period was 16 months and the study was completed to provide a complete follow-up until patient death or 3 years for all surviving patients&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Treatment procedures</span><p id="par0040" class="elsevierStylePara elsevierViewall">Both OL-HDF and hemodialysis were performed with ultrapure dialysis fluids and the length of dialysis sessions in each treatment modality was not modified&#46; For patients on postdilution OL-HDF&#44; a minimum of 18<span class="elsevierStyleHsp" style=""></span>L&#47;session of replacement volume was requested&#46; Patients not receiving the allocated treatment modality for more than 2 consecutive months were withdrawn from the study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Censored observations</span><p id="par0045" class="elsevierStylePara elsevierViewall">In the original study&#44; patients were observed until each enrolled patient completed 3 years of follow-up&#44; until premature termination&#44; or until death&#46; In the original study&#44; 355 out of 906 patients &#40;39&#46;2&#37;&#41; with premature termination were censored before completing the 3-year follow-up&#46; For the present study&#44; the principal investigators at each participating center were contacted to provide information on survival status at 3 years for each censored observation&#46; Each principal investigator contacted the renal transplant unit where patients received a kidney transplant or other hemodialysis facilities where the patients were receiving treatment from the time of censoring&#46; The date and cause of death for each participating patient censored during the study were recorded to calculate patient survival in the ITT population&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">All-cause mortality&#44; as well as cardiovascular death&#44; cachexia&#44; infection&#44; tumors&#44; sudden death and death from other causes were described by means of the Kaplan&#8211;Meier method&#46; The log-rank test was used for hypothesis testing&#44; and the hazard ratio and its 95&#37; confidence interval &#40;95&#37; CI&#41; were estimated from the unadjusted Cox model&#46; Additional multivariate Cox regression sensitivity analyses were conducted with adjustment by age&#44; gender&#44; diabetes&#44; the Charlson comorbidity index &#40;the original scale and also excluding diabetes&#41; and the type of vascular access&#46; Time-dependent Cox analysis&#44; which included the time of transplantation<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> as well as the cumulative incidence curves of progression in a competing risks framework&#44; with transplantation without death as a competing event&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14&#44;15</span></a> were also assessed to check the robustness of the study results&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Two-sided significance tests were used throughout&#44; and a <span class="elsevierStyleItalic">P</span>-value of &#60;0&#46;05 was considered significant&#46; All statistical analyses were performed using the SAS 9&#46;2 statistical package&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Outcome of censored observations</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of 906 patients included in the randomization&#44; 355 &#40;39&#46;18&#37;&#41; prematurely discontinued the study because of kidney transplantation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>180&#44; 19&#46;87&#37;&#41;&#44; change of dialysis unit &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#44; 6&#46;40&#37;&#41;&#44; organizational changes &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#44; 3&#46;64&#37;&#41;&#44; withdrawal of consent &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#44; 2&#46;98&#37;&#41;&#44; need for a temporary catheter &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#44; 2&#46;10&#37;&#41;&#44; change of treatment &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44; 1&#46;66&#37;&#41; or other&#44; non-predefined reasons &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44; 2&#46;54&#37;&#41;&#46; In the present analysis&#44; a 3-year follow-up was completed for all these patients with a premature termination&#46; At 3 years&#44; 305 patients were alive&#44; 47 patients had died and only 3 patients were censored prematurely on the last date when known to be alive&#46; Thus&#44; the mean follow-up was 2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8 years and the median observation time for censored patients was 3&#46;0 years&#46; Mortality after discontinuation of the study was similar in both groups&#58; 4&#46;04 per 100 patient-year in the HD arm and 5&#46;27 per 100 patient-year in the OL-HDF arm&#46; The causes of mortality in discontinued patients in each arm are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no significant differences in the death rate in the 2 arms of the trial according to the causes of patient discontinuation &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">All-cause mortality in the intention-to-treat population</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the 3-year follow-up&#44; 207 patients died on treatment and 47 patients died after discontinuation of the study&#59; thus&#44; 254 out of 906 patients died &#40;28&#46;03&#37;&#41; during follow-up&#44; with a 3-year all-cause mortality rate of 24&#46;78&#37; and 31&#46;33&#37; in the OL-HDF and the HD groups&#44; respectively&#46; Kaplan&#8211;Meier survival curves with the ITT population with only 3 censored patients showed that patient survival was lower in patients allocated to the HD arm than in those allocated to OL-HDF arm &#40;log-rank <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Univariate Cox regression analysis showed that patients allocated to the OL-HDF group had a 24&#37; risk reduction &#40;hazard ratio &#91;95&#37; CI&#93;&#58; 0&#46;76 &#91;0&#46;59 to 0&#46;98&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41; for mortality for any cause &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The main causes of death were cardiovascular diseases &#40;42&#46;5&#37;&#41; and infectious diseases &#40;16&#46;9&#37;&#41; and there were no significant differences between groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Sensitivity analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Sensitivity analyses were performed on the basis of the following variables&#44; which were found to be independent predictors for all-cause mortality&#58; age&#44; gender&#44; diabetes&#44; the Charlson comorbidity index and vascular access&#46; These variables were included in 3 different multivariate analyses to assess the covariate-adjusted risk estimates for the intervention &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; When these covariates were included&#44; the effect of treatment was on the verge of significance &#40;model I&#41;&#46; In model II&#44; renal transplantation was added to model I as a time-dependent covariate and the adjusted risk estimate for the intervention was identical to model I&#46; Finally&#44; in model III&#44; an adjusted risk estimate was done considering renal transplantation as the only cause for censoring&#46; The treatment risk estimates were also calculated in all subgroups arising from these variables&#44; using the original categories for nominal variables and tertiles for continuous variables&#46; All hazard ratios were consistent for both types of analysis and the statistical tests for interaction were not significant &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In this analysis&#44; male and older &#40;upper tertile of age&#41; patients&#44; as well as patients in the upper tertile of the Charlson comorbidity index&#44; obtained significant benefit from the intervention&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">All-cause mortality by time-dependent and competing risks for transplantation</span><p id="par0075" class="elsevierStylePara elsevierViewall">Since the underlying risk of death is known to change after transplantation&#44; we modeled all-cause mortality taking into account the time of transplantation in a time-dependent approach&#46; The time-dependent Cox analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; showed very similar results to the main analysis with a hazard ratio &#91;95&#37; CI&#93; of 0&#46;77 &#91;0&#46;60 to 0&#46;99&#93; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;043&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Survival analysis was repeated to assess the consistency of the results by considering renal transplantation as a competing event and consequently death after transplantation was not considered&#46; For the other patients discontinuing the study&#44; complete follow-up until 3 years was considered and events occurring after discontinuation of the study were included&#46; Survival curves for both treatment groups are shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; confirming that patients allocated to OL-HDF group had a higher survival than patients allocated to the HD arm &#40;Gray&#39;s test&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In the present study&#44; we conducted a new analysis of the ESHOL-study with the ITT population with a complete follow-up for 3 years after trial enrollment&#46; In the previous study&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> patients who were alive when they discontinued the study for any reason were censored at the time of withdrawal&#46; As in other studies conducted in patients on hemodialysis&#44; there was a high rate of censored observations before 3 years &#40;39&#46;2&#37;&#41; and the main reason for censoring was renal transplantation&#44; accounting for more than 50&#37; of cases&#46; Additionally&#44; the proportion of patients receiving a kidney transplant was slightly higher in the HDF-OL arm than in the HD arm &#40;101 out of 456 patients versus 79 out of 450 patients&#41;&#44; suggesting that&#44; despite the randomized allocation of patients to both arms&#44; there may have been an unbalanced risk between the 2 groups&#46; In survival analyses&#44; all subjects at risk of experiencing an event constitute the risk set&#46; Standard survival analytical methods such as the Kaplan&#8211;Meier method assume that censoring is &#8220;independent&#8221;&#44; this is&#44; that patients who are censored at a certain time point should be representative of those still at risk &#40;and&#44; thus&#44; in the risk set&#41; at that time point&#46; In the ESHOL study&#44; we observed that censoring was not independent&#44; since censored patients had a lower risk of death than those continuing in the trial &#40;the risk set&#41;&#46; These results could be expected in hemodialysis patients who were censored mainly because of renal transplantation&#44; since it is well known that the risk of death decreases after renal transplantation in chronic hemodialysis patients&#46; Nevertheless&#44; according to the randomized design of the trial&#44; the risk of death in censored patients in both arms of the trial was not different &#40;4&#46;04 per 100 patients-year in the HD arm and 5&#46;27 per 100 patients-year in the HDF-OL arm&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">&#8220;Intention to treat&#8221; is a strategy to analyze randomized controlled trials comparing patients according to the initial random allocation&#46; This is generally interpreted as including all patients&#44; regardless of whether they actually satisfied the entry criteria&#44; the treatment actually received&#44; and subsequent withdrawal or deviation from the protocol&#46; The ITT approach maintains treatment groups that are similar apart from random variation and allows for non-compliance and deviations from policy by clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> This approach characterizes the effectiveness of the intervention and offers information on the potential benefit observed in clinical practice&#46; If an ITT analysis is not done&#44; clinical effectiveness may be overestimated&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In the ESHOL study&#44; an ITT analysis was not originally planned since we expected a significant percentage of withdrawals &#40;15&#37; per year&#41; and assumed that it would not affect the main conclusions of our study&#46; Indeed&#44; other studies conducted in hemodialysis patients to evaluate the benefit of different interventions were performed with a similar design&#46; To overcome this limitation and to gain further insight into the effectiveness of our intervention&#44; we decided to conduct the present study with a complete ITT analysis of the ESHOL study&#46; In the univariate analysis of the present study&#44; we were able to demonstrate that patients allocated to the OL-HDF arm had a significant 24&#37; risk reduction of death compared with patients allocated to the HD arm&#46; Importantly&#44; the death rate was lower in this ITT population than in patients continuing under hemodialysis&#46; Thus&#44; this new analysis is less powered to detect a difference between groups&#46; This loss of statistical power partly explains why&#44; after adjustment for age&#44; gender&#44; diabetes&#44; the Charlson comorbidity index and vascular access in the multivariate analysis&#44; the 20&#37; risk reduction was only on the threshold of significance &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;086&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Despite the usefulness of ITT analysis to analyze the ESHOL study&#44; the main reason for withdrawal was renal transplantation&#46; This is a classic example of competing risk in nephrology and&#44; in this situation&#44; it has been proposed that an alternative way to analyze data is by a proportional cause-specific hazards model with application of Cox regression analysis for each of the specific event types&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> In each of these models&#44; the competing events are treated as censored observations&#46; We have also performed this analysis &#40;model III of the sensitivity analysis&#41; and we observed a statistically significant 25&#37; reduction in the risk of death by adjusting for confounders in patients allocated to the OL-HDF arm&#46; Finally&#44; the results of the 2 approaches to assess the potential effect of transplantation on the results&#44; the time-dependent Cox analysis and the competing events approach&#44; both yielded similar results to that of the primary raw analysis and confirmed the positive conclusions of the trial&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the last year&#44; 4 meta-analyses have been published that analyze the effect of convective against diffusive therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">18&#8211;21</span></a> Susantitaphong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> evaluated randomized controlled trials comparing the effect of convective therapies including high-flux dialysis&#44; hemofiltration or hemodiafiltration versus low-flux dialysis&#46; The 3 other most recent meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">19&#8211;21</span></a> that included all 3 RCT with mortality as the primary endpoint<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;4&#44;8</span></a> to compare convective techniques versus low- or high-flux hemodialysis were positive in terms of survival&#44; but the results were inconclusive&#44; probably due to the disparity of criteria and confounding factors&#46; Only the meta-analysis of the EuDial working group&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> including only RCT comparing OL-HDF versus hemodialysis &#40;hemofiltration and AFB were excluded&#41; showed the superiority of OL-HDF to HD on overall and cardiovascular mortality&#46; The discrepancies between these meta-analyses can be explained by the different research questions&#44; different selection criteria of clinical trials and potential confounding factors &#40;delivered dose of convective therapy&#44; pre- or postdilution infusion or treatment modality&#41;&#46; A revised definition of HDF was published by the EuDial group&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> in which HDF is a blood purification therapy combining diffusive and convective solute transport using a high-flux membrane characterized by an ultrafiltration coefficient greater than 20<span class="elsevierStyleHsp" style=""></span>mL&#47;h&#47;mmHg&#47;m<span class="elsevierStyleSup">2</span> and a sieving coefficient for &#946;<span class="elsevierStyleInf">2</span>-microglobulin greater than 0&#46;6&#59; convective transport is achieved by an effective convection volume of at least 20&#37; of the total blood volume processed&#46; If these criteria were applied when selecting the RCT for inclusion in meta-analyses&#44; none of the 4 published meta-analyses would meet them&#46; It can therefore be questioned whether these meta-analyses are valid to answer the question of whether high-volume HDF improves survival compared with hemodialysis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In summary&#44; the results of this reanalysis of the ESHOL trial confirm that high efficiency postdilution OL-HDF reduces all-cause mortality versus conventional hemodialysis in prevalent patients&#46; These results are consistent independently of the statistical analysis employed&#46; The original results observed in the ESHOL study&#44; which censored patients discontinuing the study for any reason&#44; were confirmed in the present study&#44; which considered all-cause mortality in the ITT population without censures and also considered all-cause mortality by time-dependent and competing risks for transplantation&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "identificador" => "sec0050"
              "titulo" => "Outcome of censored observations"
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            1 => array:2 [
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              "titulo" => "All-cause mortality in the intention-to-treat population"
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              "titulo" => "Sensitivity analysis"
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              "titulo" => "All-cause mortality by time-dependent and competing risks for transplantation"
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          "titulo" => "Discussion"
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          "titulo" => "Acknowledgments"
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          "titulo" => "References"
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    "tienePdf" => true
    "fechaRecibido" => "2015-06-15"
    "fechaAceptado" => "2015-10-05"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:4 [
            0 => "Convective therapies"
            1 => "Intention to treat"
            2 => "On-line hemodiafiltration"
            3 => "Survival"
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        ]
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          "palabras" => array:4 [
            0 => "Terapias convectivas"
            1 => "Intenci&#243;n de tratar"
            2 => "Hemodiafiltraci&#243;n <span class="elsevierStyleItalic">on-line</span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The ESHOL study showed that post-dilution online hemodiafiltration &#40;OL-HDF&#41; reduces all-cause mortality versus hemodialysis&#46; However&#44; during the observation period&#44; 355 patients prematurely completed the study and&#44; according to the study design&#44; these patients were censored at the time of premature termination&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to investigate the outcome of patients who discontinued the study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During follow-up&#44; 207 patients died while under treatment and 47 patients died after discontinuation of the study&#46; Compared with patients maintained on hemodialysis&#44; those randomized to OL-HDF had lower all-cause mortality &#40;12&#46;4 versus 9&#46;46 per 100 patient-years&#44; hazard ratio and 95&#37; CI&#58; 0&#46;76&#59; &#91;0&#46;59 to 0&#46;98&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#46; For all-cause mortality by time-dependent covariates and competing risks for transplantation&#44; the time-dependent Cox analysis showed very similar results to the main analysis with a hazard ratio of 0&#46;77 &#40;0&#46;60 to 0&#46;99&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;043&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results of this analysis of the ESHOL trial confirm that post-dilution OL-HDF reduces all-cause mortality versus hemodialysis in prevalent patients&#46; The original results of the ESHOL study&#44; which censored patients discontinuing the study for any reason&#44; were confirmed in the present ITT population without censures and when all-cause mortality was considered by time-dependent and competing risks for transplantation&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El estudio ESHOL ha demostrado que la hemodiafiltraci&#243;n <span class="elsevierStyleItalic">on line</span> &#40;HDF-OL&#41; posdiluci&#243;n reduce la mortalidad por todas las causas respecto a la hemodi&#225;lisis &#40;HD&#41; en pacientes prevalentes&#46; Sin embargo&#44; durante el periodo de observaci&#243;n&#44; 355 pacientes finalizaron prematuramente el estudio&#44; de acuerdo con el dise&#241;o del mismo&#46; Estos pacientes fueron censurados en el momento de la finalizaci&#243;n prematura&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue investigar los eventos de los pacientes que abandonaron el estudio&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Reanalizar los datos de supervivencia utilizando la poblaci&#243;n por intenci&#243;n de tratar en los 3 a&#241;os de seguimiento&#46; Los datos fueron analizados considerando tambi&#233;n el trasplante renal como evento competitivo de la muerte del paciente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Durante el seguimiento&#44; 207 pacientes fallecieron durante el tratamiento y 47 despu&#233;s de abandonar el estudio&#46; Comparados con aquellos pacientes que se mantuvieron en HD&#44; los que fueron aleatorizados a HDF-OL tuvieron una mortalidad total menor &#40;12&#44;4 vs&#46; 9&#44;46 por 100&#47;pacientes&#47;a&#241;o&#44; <span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93; e IC 95&#37;&#58; 0&#44;76 &#91;0&#44;59-0&#44;98&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#46; La mortalidad total por todas las causas&#44; teniendo en consideraci&#243;n el riesgo competitivo del trasplante renal y tiempo-dependiente&#44; mostr&#243; en el an&#225;lisis de Cox tiempo-dependiente resultados similares al an&#225;lisis principal con un HR de 0&#44;77 &#40;0&#44;60-0&#44;99&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;043&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los resultados del rean&#225;lisis del estudio ESHOL se confirman cuando se aplica el an&#225;lisis en la poblaci&#243;n por intenci&#243;n de tratar sin censurar ninguna observaci&#243;n y considerando la mortalidad por todas las causas dependiente del tiempo y del riesgo competitivo del trasplante renal&#46;</p></span>"
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            "titulo" => "Objetivos"
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            "titulo" => "M&#233;todos"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">The institutions and investigators in the study group are listed in the <a class="elsevierStyleCrossRef" href="#sec0080">appendix</a>&#46;</p>"
        "identificador" => "fn1"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Maduell F&#44; Moreso F&#44; Mora-Maci&#224; J&#44; Pons M&#44; Ramos R&#44; Carreras J&#44; et al&#46; Rean&#225;lisis del estudio ESHOL&#58; mortalidad por todas las causas considerando riesgos de competici&#243;n y tiempo-dependientes para trasplante renal&#46; 2016&#59;36&#58;156&#8211;163&#46;</p>"
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            "apendice" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The following institutions and investigators participated in the ESHOL study&#58;</p> <p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">CETIRSA&#44; Barcelona</span>&#58; M&#46; Pons&#44; B&#46; Insens&#233;&#44; C&#46; Perez&#44; T&#46; Feliz&#59; <span class="elsevierStyleItalic">Hospital San Antonio Abad&#44; Vilanova i la Geltru</span>&#58; R&#46; Ramos&#44; M&#46; Barbetta&#44; C&#46; Soto&#59; <span class="elsevierStyleItalic">Fresenius Medical Care&#44; Granollers</span>&#58; J&#46; Mora&#44; A&#46; Juan&#44; O&#46; Ibrik&#59; <span class="elsevierStyleItalic">Diaverum Baix Llobregat&#44; Hospitalet</span>&#58; A&#46; Foraster&#44; J&#46; Carreras&#59; <span class="elsevierStyleItalic">Fresenius Medical Care&#44; Hospitalet&#58;</span> F&#46; Moreso&#44; M&#46; Hueso&#44; J&#46; Nin&#44; A&#46; Fern&#225;ndez&#59; <span class="elsevierStyleItalic">Fresenius Medical Care&#44; Reus</span>&#58; J&#46; Soler&#44; M&#46; Arruche&#44; C&#46; S&#225;nchez&#44; J&#46; Vidiella&#59; <span class="elsevierStyleItalic">Fresenius Medical Care Diagonal&#44; Barcelona</span>&#58; F&#46; Barbosa&#44; M&#46; Chin&#233;&#44; S&#46; Hurtado&#59; <span class="elsevierStyleItalic">CETIRSA&#44; Terrassa</span>&#58; J&#46; Llibre&#44; A&#46; Ruiz&#44; M&#46; Serra&#44; M&#46; Salv&#243;&#44; T&#46; Poyuelo&#59; <span class="elsevierStyleItalic">Hospital Cl&#237;nic&#44; Barcelona</span>&#58; F&#46; Maduell&#44; M&#46; Carrera&#44; N&#46; Fontser&#233;&#44; M&#46; Arias&#44; Josep M Campistol&#44;&#59; <span class="elsevierStyleItalic">Fresenius Medical Care Julio Verne&#44; Barcelona</span>&#58; A&#46; Mer&#237;n&#44; L&#46; Ribera&#59; <span class="elsevierStyleItalic">Fundaci&#243; Althaia&#44; Manresa</span>&#58; JM&#46; Galceran&#44; J&#46; M&#242;dol&#44; E&#46; Moliner&#44; A&#46; Ramirez&#59; <span class="elsevierStyleItalic">Hospital Santa Tecla&#44; Tarragona</span>&#58; J&#46; Aguilera&#44; M&#46; Alvarez&#59; <span class="elsevierStyleItalic">Diaverum Bonanova&#44; Barcelona</span>&#58; B&#46; de la Torre&#44; M&#46; Molera&#59; <span class="elsevierStyleItalic">Diaverum IHB&#44; Barcelona</span>&#58; J&#46; Casellas&#44; G&#46; Mart&#237;n&#59; <span class="elsevierStyleItalic">Fundaci&#243; Puigvert&#44; Barcelona</span>&#58; E&#46; Andres&#44; E&#46; Coll&#59; <span class="elsevierStyleItalic">Hospital Josep Trueta&#44; Girona</span>&#58; M&#46; Valles&#44; C&#46; Mart&#237;nez&#59; <span class="elsevierStyleItalic">Hospital General&#44; Vic</span>&#58; E&#46; Castellote&#59; <span class="elsevierStyleItalic">Diaverum&#44; Matar&#243;</span>&#58; JM&#46; Casals&#44; J&#46; Gab&#224;s&#44; M&#46; Romero&#59; <span class="elsevierStyleItalic">Hospital Universitari Bellvitge&#44; Hospitalet</span>&#58; A&#46; Martinez-Castelao&#44; X&#46; Fulladosa&#59; <span class="elsevierStyleItalic">Hospital de Terrassa</span>&#58; M&#46; Ramirez-Arellano&#44; M Fulquet&#59; <span class="elsevierStyleItalic">Diaverum Verge de Montserrat&#44; Santa Coloma</span>&#58; A&#46; Pelegr&#237;&#44; M&#46; el Manouari&#44; N&#46; Ramos&#59; Centre <span class="elsevierStyleItalic">Secretari Coloma&#44; Barcelona</span>&#58; J&#46; Bartolom&#233;&#59; <span class="elsevierStyleItalic">Hospital de Figueres</span>&#44; R&#46; Sans&#59; <span class="elsevierStyleItalic">Hospital Arnau de Vilanova&#44; Lleida</span>&#58; E&#46; Fern&#225;ndez&#44; F&#46; Sarr&#243;&#59; <span class="elsevierStyleItalic">Hospital Santa Creu&#44; Tortosa&#58;</span> T&#46; Compte&#59; <span class="elsevierStyleItalic">Diaverum Nephros&#44; Barcelona</span>&#58; F&#46; Marco&#44; R&#46; Mauri&#59; <span class="elsevierStyleItalic">Cl&#237;nica Girona</span>&#58; J&#46; Bronsoms&#46;</p> <p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical Trials Unit</span>&#58; JA&#46; Arnaiz&#44; H&#46; Beleta&#44; A&#46; Pejenaute &#40;UASP Farmacolog&#237;a Cl&#237;nica&#44; Hospital Cl&#237;nic Barcelona&#41;&#46;</p> <p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Statistical analysis</span>&#58; F&#46; Torres&#44; J&#46; R&#237;os and J&#46; Lara &#40;Biostatistics Unit&#44; School of Medicine&#44; Universitat Aut&#242;noma de Barcelona&#59; Biostatistics and Data Management Platform&#44; IDIBAPS&#44; Hospital Clinic&#59; Barcelona&#41;&#46;</p>"
            "etiqueta" => "Appendix"
            "identificador" => "sec0080"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves for 36-month survival in the intention-to-treat population &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031 by the log-rank test&#41;&#46; HD denotes hemodialysis&#44; and OL-HDF&#44; on-line hemodiafiltration&#46;</p>"
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        "etiqueta" => "Fig&#46; 2"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sensitivity analyses for the main outcome showing hazard ratios &#91;95&#37; CI&#93; for the intervention based on relevant variables that were found to be independent predictors for all-cause mortality&#46; Multivariate I&#58; age&#44; gender&#44; diabetes and vascular access&#46; Multivariate II&#58; age&#44; gender&#44; diabetes&#44; vascular access and the Charlson comorbidity index&#46; Multivariate III&#58; age&#44; gender&#44; diabetes&#44; vascular access&#44; Charlson comorbidity index and censoring for transplantation&#46; 1T&#44; 2T and 3T&#58; first&#44; second and third tertiles&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves for 36-month survival in competitive risks cumulative incidence of death &#40;Gray&#39;s test&#44; <span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; HD denotes hemodialysis&#44; and OL-HDF&#44; on-line hemodiafiltration&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">HD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>164&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">OL-HDF group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>191&#41;</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Hazard ratio &#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col"><span class="elsevierStyleItalic">P</span> value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Patient-years at risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">470&#46;6</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">531&#46;8</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;100 patient-yr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;100 patient-Yr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Death from any cause</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;38 &#91;0&#46;76 to 2&#46;49&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiovascular cause</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;78 &#91;0&#46;61 to 5&#46;21&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;44 &#91;0&#46;04 to 4&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;496&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7 &#91;0&#46;28 to 26&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;369&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mesenteric trombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;22 &#91;0&#46;43 to 11&#46;47&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;326&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dysrhythmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Peripheral arteriopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;06 &#91;0&#46;32 to 3&#46;48&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;919&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tumor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;59 &#91;0&#46;10 to 3&#46;52&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;557&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sudden death</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cachexia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;91 &#91;0&#46;13 to 6&#46;43&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;921&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Death from other causes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;87 &#91;0&#46;18 to 4&#46;32&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;868&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">HD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>164&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">OL-HDF group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>191&#41;</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Hazard ratio &#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col"><span class="elsevierStyleItalic">P</span> value<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Patient-years at risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">470&#46;6</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">531&#46;8</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;<span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;100 patient-yr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;<span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;100 patient-yr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#47;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;63 &#91;0&#46;78 to 16&#46;79&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change of HD center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;70 &#91;0&#46;56 to 13&#46;00&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Organizational changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50 &#91;0&#46;10 to 2&#46;49&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;390&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Withdrawal of consent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;35 &#91;0&#46;22 to 8&#46;07&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temporary catheter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;55 &#91;0&#46;26 to 24&#46;62&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55 &#91;0&#46;05 to 6&#46;07&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other reasons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;17 &#91;0&#46;24 to 5&#46;82&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">HD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>450&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">OL-HDF Group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>456&#41;</th><th class="td" title="table-head  " align="center" valign="bottom" scope="col">Hazard ratio &#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col"><span class="elsevierStyleItalic">P</span> value<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Patient-years at risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">1138&#46;0</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">1194&#46;4</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;100 patient-yr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of events&#47;100 patient-yr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Death from any cause</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76 &#91;0&#46;59 to 0&#46;98&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiovascular cause</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;73 &#91;0&#46;50 to 1&#46;07&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63 &#91;0&#46;26 to 1&#46;53&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01 &#91;0&#46;51 to 1&#46;99&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;982&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mesenteric trombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;80 &#91;0&#46;24 to 2&#46;62&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;709&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57 &#91;0&#46;28 to 1&#46;17&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dysrhythmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48 &#91;0&#46;12 to 1&#46;92&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Peripheral arteriopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;89 &#91;0&#46;17 to 20&#46;88&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;596&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56 &#91;0&#46;30 to 1&#46;05&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;065&nbsp;\t\t\t\t\t\t\n
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