TY - JOUR
T1 - Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure
AU - Blankestijn, Peter J
AU - Vernooij, Robin W M
AU - Hockham, Carinna
AU - Strippoli, Giovanni F M
AU - Canaud, Bernard
AU - Hegbrant, Jörgen
AU - Barth, Claudia
AU - Covic, Adrian
AU - Cromm, Krister
AU - Cucui, Andrea
AU - Davenport, Andrew
AU - Rose, Matthias
AU - Török, Marietta
AU - Woodward, Mark
AU - Bots, Michiel L
AU - CONVINCE Scientific Committee Investigators
AU - Grooteman, M.P.C.
N1 - Funding Information: Supported by the European Commission Research and Innovation, Horizon 2020 (H2020-SC1-2016-2017), under the topic SC1-PM-10-2017: Comparing the effectiveness of existing health care interventions in the adult population (grant no. 754803-2). Publisher Copyright: © 2023 Massachusetts Medical Society.
PY - 2023/8/24
Y1 - 2023/8/24
N2 - BACKGROUND: Several studies have suggested that patients with kidney failure may benefit from high-dose hemodiafiltration as compared with standard hemodialysis. However, given the limitations of the various published studies, additional data are needed.METHODS: We conducted a pragmatic, multinational, randomized, controlled trial involving patients with kidney failure who had received high-flux hemodialysis for at least 3 months. All the patients were deemed to be candidates for a convection volume of at least 23 liters per session (as required for high-dose hemodiafiltration) and were able to complete patient-reported outcome assessments. The patients were assigned to receive high-dose hemodiafiltration or continuation of conventional high-flux hemodialysis. The primary outcome was death from any cause. Key secondary outcomes were cause-specific death, a composite of fatal or nonfatal cardiovascular events, kidney transplantation, and recurrent all-cause or infection-related hospitalizations.RESULTS: A total of 1360 patients underwent randomization: 683 to receive high-dose hemodiafiltration and 677 to receive high-flux hemodialysis. The median follow-up was 30 months (interquartile range, 27 to 38). The mean convection volume during the trial in the hemodiafiltration group was 25.3 liters per session. Death from any cause occurred in 118 patients (17.3%) in the hemodiafiltration group and in 148 patients (21.9%) in the hemodialysis group (hazard ratio, 0.77; 95% confidence interval, 0.65 to 0.93).CONCLUSIONS: In patients with kidney failure resulting in kidney-replacement therapy, the use of high-dose hemodiafiltration resulted in a lower risk of death from any cause than conventional high-flux hemodialysis. (Funded by the European Commission Research and Innovation; CONVINCE Dutch Trial Register number, NTR7138.).
AB - BACKGROUND: Several studies have suggested that patients with kidney failure may benefit from high-dose hemodiafiltration as compared with standard hemodialysis. However, given the limitations of the various published studies, additional data are needed.METHODS: We conducted a pragmatic, multinational, randomized, controlled trial involving patients with kidney failure who had received high-flux hemodialysis for at least 3 months. All the patients were deemed to be candidates for a convection volume of at least 23 liters per session (as required for high-dose hemodiafiltration) and were able to complete patient-reported outcome assessments. The patients were assigned to receive high-dose hemodiafiltration or continuation of conventional high-flux hemodialysis. The primary outcome was death from any cause. Key secondary outcomes were cause-specific death, a composite of fatal or nonfatal cardiovascular events, kidney transplantation, and recurrent all-cause or infection-related hospitalizations.RESULTS: A total of 1360 patients underwent randomization: 683 to receive high-dose hemodiafiltration and 677 to receive high-flux hemodialysis. The median follow-up was 30 months (interquartile range, 27 to 38). The mean convection volume during the trial in the hemodiafiltration group was 25.3 liters per session. Death from any cause occurred in 118 patients (17.3%) in the hemodiafiltration group and in 148 patients (21.9%) in the hemodialysis group (hazard ratio, 0.77; 95% confidence interval, 0.65 to 0.93).CONCLUSIONS: In patients with kidney failure resulting in kidney-replacement therapy, the use of high-dose hemodiafiltration resulted in a lower risk of death from any cause than conventional high-flux hemodialysis. (Funded by the European Commission Research and Innovation; CONVINCE Dutch Trial Register number, NTR7138.).
KW - Chronic Kidney Disease
KW - Clinical Medicine
KW - Clinical Medicine General
KW - Kidney Replacement Therapy
KW - Nephrology
UR - http://www.scopus.com/inward/record.url?scp=85165095480&partnerID=8YFLogxK
U2 - https://doi.org/10.1056/NEJMoa2304820
DO - https://doi.org/10.1056/NEJMoa2304820
M3 - Article
C2 - 37326323
SN - 0028-4793
VL - 389
SP - 700
EP - 709
JO - The New England journal of medicine
JF - The New England journal of medicine
IS - 8
ER -