Abstract: FR-PO784

Acetate Free Dialysis and Mortality in the French Renal Epidemiology Information Network Registry (REIN)

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Mercadal, Lucile, AP-HP, Pitié Salpetrière hospital, Paris, France
  • Ndoye, Abdoulaye, INSERM, Villejuif, France
  • Metzger, Marie, CESP U1018, INSERM, Villejuif, France
  • Jacquelinet, Christian, Agence de la biomedecine, Saint-Denis La Plaine, France
  • Stengel, Benedicte, Inserm ? CESP, Villejuif, France

We previously found a reduced mortality associated with the use of acetate free dialysis (AFD) in subjects older than 70 years old. As the use of these dialysates made with chlorhydric or citric acid steadily increases since 2010, we wonder whether this result can be reproduced in the last recent years.


All patients who started HD from 2010 to 2013 were classified according to their exposure to AFD: exposed in a 100% AFD dialysis center, exposed in a mixed center (both standard and AFD) and unexposed. Cox survival analysis was performed in 26 304 incident patients, adjusted for 15 baseline co-morbidities and biological data and accounting for patient clustering within facilities. Exposure to AFD and hemodiafiltration (HDF) status were analyzed as time-dependent variables. Analysis was censored at Dec 31, 2014, or at kidney transplantation, lost to follow-up, dialysis weaning or transfer to peritoneal dialysis. The Cox model was used for the overall population and by age group, <70 or ≥70 years.


During the study period, 16 124 subjects were exclusively dialyzed in centers with standard dialysate, 380 in 100% AFD centers, 7538 in mixed centers and 6481 had a change in their AFD exposure. Being dialyzed in mixed centers was associated with a mortality HR of 0.53 (0.47-0.60) for subjects <70years old and of 0.57 (0.52-0.62) for those ≥70. Being dialyzed in 100% AFD centers was associated with a mortality HR of 0.80 (0.59-1.09) for subjects <70 years old and of 0.68 (0.54-0.87) for those ≥ 70. The Cox on the overall population found a mortality HR of 0.56 (0.51-0.61) for being dialyzed in mixed centers and of 0.73 (0.6-0.89) for 100%AFD centers.


Using an entirely new data set of subjects exposed to AFD in the REIN registry, we confirm that being dialyzed with AFD is associated with a reduced mortality risk. In a larger AFD exposed population, the mortality reduction seems more constant with age.