According to a recent study from the CONVINCE collaboration led by the University Medical Center Utrecht, the mortality of patients with kidney failure was 23 percent lower in patients treated with high-dose hemodiafiltration compared to those treated with high-flow hemodialysis.
The study findings, published in the New England Journal of Medicine, are the first randomized trial to evaluate the two therapies on a global scale. The results suggest that expanding the use of high-dose hemofiltration may benefit patients.
Chronic kidney disease, a major global health problem, is estimated to affect 830 million people worldwide. Dialysis is used to clean the blood by removing waste products, a task usually performed by the kidneys themselves when they are no longer able to complete their work. There are more than four million dialysis patients worldwide.
Hemodialysis is the most common form of dialysis used to treat kidney failure. Although it has improved over the years, it is not good at removing larger molecules from the blood. Hemodiafiltration is a newer technology that can remove larger molecules, but is not suitable for all patients because it requires higher blood flow to be effective. Previous studies have not been able to conclusively show that one method is more effective than the other.
The CONVINCE study was led by scientists from UMC Utrecht together with collaborators from University College London (UCL), Charite Universitatsmedizin Berlin, University of Bari, The George Institute for Global Health and Imperial College London, together with dialysis providers Fresenius Medical Care, Diaverum and B. Braun Avitum. This is the first multinational randomized trial comparing high-flow hemodialysis and high-dose hemodiafiltration to clarify which method is better.
A total of 1,360 patients were randomized in 61 centers in eight European countries, of whom 683 were treated with high-dose hemodiafiltration and 677 were treated with high-dose hemodialysis thrice weekly.
During a median follow-up of 30 months, all-cause mortality was 21.9% in patients treated with high-flux hemodialysis compared with 17.3% in patients treated with high-volume hemodiafiltration. This difference of 4.6% represents a 23% reduction in the risk of death.
Lead researcher Professor Peter Blankestijn (UMC Utrecht) said: “Our results show a clear survival advantage of using hemodiafiltration over hemodialysis to treat kidney failure, which equates to a 23% reduction in all-cause mortality.” I hope that hemodiafiltration can become the new standard.”
Professor Matthias Rose (Charite University, Berlin), lead author of the study and an expert in patient-reported outcomes, said: “In addition to clinical events, patient perception and thus reported outcomes are very important. We are currently conducting in-depth analyzes of the extensive patient-reported outcomes data collected in the CONVINCE trial, with results expected later this year.”
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