New data on clazakizumab, a monoclonal antibody targeting interleukin-6 (IL-6), and home hemodialysis suggest the potential of two ways to reduce the high risk for cardiovascular events in people receiving dialysis, according to presentations at the 61st European Renal Association Congress.
In one study, researchers found important reductions in inflammatory markers of cardiovascular events in people with end-stage kidney disease undergoing dialysis. A separate analysis showed a lower cardiovascular risk with home hemodialysis vs peritoneal dialysis.
Another study, also presented at the meeting, found significantly lower rates of cardiovascular events in patients with end-stage kidney disease treated with home hemodialysis compared with those receiving peritoneal dialysis.
The study included 68,645 patients identified in the United States Renal Data System and linked Medicare claims between 2005 and 2018.
With a mean follow-up of 1.8 years, home hemodialysis was associated with a slightly lower adjusted risk for cardiovascular events than peritoneal dialysis (hazard ratio [HR], 0.92). However, the home hemodialysis patients had as much as a 42% lower adjusted risk for stroke (HR, 0.58), and a 17% lower adjusted risk for acute coronary syndrome (HR, 0.83) vs those receiving peritoneal dialysis, with no statistically significant difference in risk for heart failure (HR, 1.05).
In terms of mortality, home hemodialysis was meanwhile associated with 22% lower adjusted risk for cardiovascular death (HR, 0.78) and 8% lower adjusted risk for all-cause death (HR, 0.92) compared with peritoneal dialysis.
"Previous studies showed a lower rate of cardiovascular hospitalizations with home hemodialysis; however, no study has specifically examined cardiovascular events," Shah said, adding that further studies also need to compare outcomes by home dialysis modalities.
Key factors, including the frequency of dialysis, could explain the differences, she explained.
"We believe home hemodialysis patients receive more frequent and longer dialysis than peritoneal dialysis, which results in better solute clearance and better volume removal, therefore resulting in better control of parameters associated with bone and mineral metabolism and reduction in left ventricular volume and mass," Shah said.
"This eventually lowers the risk of cardiovascular events and overall cardiovascular death," she said.
"Clinicians should use this information in shared decision-making and counseling of patients with kidney disease."
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