Bibliographic Details
| Title: |
Real-world effectiveness of hemodialysis modalities: a retrospective cohort study |
| Authors: |
Yan Zhang, Anke Winter, Belén Alejos Ferreras, Paola Carioni, Otto Arkossy, Michael Anger, Robert Kossmann, Len A. Usvyat, Stefano Stuard, Franklin W. Maddux |
| Source: |
BMC Nephrology, Vol 26, Iss 1, Pp 1-11 (2025) |
| Publisher Information: |
BMC, 2025. |
| Publication Year: |
2025 |
| Collection: |
LCC:Diseases of the genitourinary system. Urology |
| Subject Terms: |
Hemodiafiltration, High-flux hemodialysis, Mortality, Cardiovascular mortality, Kidney replacement therapy, Diseases of the genitourinary system. Urology, RC870-923 |
| More Details: |
Abstract Background Results from the CONVINCE clinical trial suggest a 23% mortality risk reduction among patients receiving high-volume (> 23 L) hemodiafiltration. We assessed the real-world effectiveness of blood-based kidney replacement therapy (KRT) with hemodiafiltration vs. hemodialysis in a large, unselected patient population treated prior to and during the COVID-19 pandemic. Methods In this retrospective cohort study, we analyzed pseudonymized data from 85,117 adults receiving in-center care across NephroCare clinics in Europe, the Middle East, and Africa during 2019–2022. Cox regression models with KRT modality and coronavirus disease 2019 (COVID-19) status as time-varying covariates, and adjusted for multiple confounders, were used to estimate all-cause (primary) and cardiovascular (secondary) mortality. Subgroup analyses were performed for age, dialysis vintage, COVID-19 status, diabetes, and cardiovascular disease. Results At baseline, 55% of patients were receiving hemodialysis and 45% of patients were receiving hemodiafiltration. Baseline characteristics were similar between baseline modalities, except that hemodiafiltration patients were a median of 2 years younger, had higher percentage of fistula access (66% vs. 47%), and had longer mean dialysis vintages (4.4 years vs. 2.6 years). Compared with hemodialysis, hemodiafiltration was associated with an adjusted hazard ratio (HR) for all-cause mortality of 0.78 (95% confidence interval [Cl], 0.76–0.80), irrespective of COVID-19 infection. The pattern of a beneficial effect of hemodiafiltration was consistently observed among all analyzed subgroups. Among patients receiving high-volume hemodiafiltration (mean convection volume ≥ 23 L), the risk of death was reduced by 30% (HR, 0.70 [95% CI, 0.68–0.72]). Hemodiafiltration was also associated with a 31% reduced risk of cardiovascular death. Conclusions Our results suggest that hemodiafiltration has a beneficial effect on all-cause and cardiovascular mortality in a large, unselected patient population and across patient subgroups in real-world settings. Our study complements evidence from the CONVINCE trial and adds to the growing body of real-world evidence on hemodiafiltration. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
1471-2369 |
| Relation: |
https://doaj.org/toc/1471-2369 |
| DOI: |
10.1186/s12882-024-03934-y |
| Access URL: |
https://doaj.org/article/6cae3b519eab4201a53a067984cf1e63 |
| Accession Number: |
edsdoj.6cae3b519eab4201a53a067984cf1e63 |
| Database: |
Directory of Open Access Journals |
