The following is a summary of the article titled “Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure,” published in the August 2023 issue of Nephrology by Blankestijn et al.
High-dose hemodiafiltration might benefit kidney failure over standard hemodialysis. Researchers performed a retrospective study to address the need for additional data, considering the constraints of existing published studies.
They conducted a pragmatic, multinational, randomized, controlled trial in which patients with kidney failure on high-flux hemodialysis for ≥3 months participated. All were eligible for ≥23L/session convection volume (needed for high-dose hemodiafiltration) and could complete patient-reported outcomes assessments. Patients were either assigned high-dose hemodiafiltration or continued conventional high-flux hemodialysis. Primary outcome: all-cause mortality. Key secondaries: cause-specific death, cardiovascular events, kidney transplant, and hospitalizations for all-cause or infection-related reasons.
The results showed that 1,360 patients were randomized, 683 for high-dose hemodiafiltration, and 677 for high-flux hemodialysis. Median follow-up was 30 months (interquartile range: 27 to 38). The hemodiafiltration group means convection volume, 25.3 liters/session. Any-cause deaths were 118 (17.3%) with hemodiafiltration and 148 (21.9%) with hemodialysis (hazard ratio: 0.77; 95% CI: 0.65 to 0.93).
They concluded that kidney-replacement therapy with high-dose hemodiafiltration reduces death risk in patients with kidney failure.
Source: nejm.org/doi/full/10.1056/NEJMoa2304820
