Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure
- PMID: 37326323
- DOI: 10.1056/NEJMoa2304820
Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure
Abstract
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.).
Copyright © 2023 Massachusetts Medical Society.
Comment in
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CONVINCE trial reports a survival benefit of haemodiafiltration compared with haemodialysis.Nat Rev Nephrol. 2023 Aug;19(8):478. doi: 10.1038/s41581-023-00740-x. Nat Rev Nephrol. 2023. PMID: 37365327 No abstract available.
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Is hemodiafiltration superior to hemodialysis in patients with kidney failure?Kidney Int. 2023 Nov;104(5):874-877. doi: 10.1016/j.kint.2023.07.012. Kidney Int. 2023. PMID: 37863633 No abstract available.
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Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure.N Engl J Med. 2023 Nov 16;389(20):e42. doi: 10.1056/NEJMc2311148. N Engl J Med. 2023. PMID: 37966298 No abstract available.
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Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure.N Engl J Med. 2023 Nov 16;389(20):e42. doi: 10.1056/NEJMc2311148. N Engl J Med. 2023. PMID: 37966299 No abstract available.
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Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure.N Engl J Med. 2023 Nov 16;389(20):e42. doi: 10.1056/NEJMc2311148. N Engl J Med. 2023. PMID: 37966300 No abstract available.
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Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure. Reply.N Engl J Med. 2023 Nov 16;389(20):e42. doi: 10.1056/NEJMc2311148. N Engl J Med. 2023. PMID: 37966301 No abstract available.
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