Kidney failure treatment

According to a recent study from the CONVINCE collaboration led by University Medical Center Utrecht, mortality in patients with kidney failure was shown to be 23% lower among those treated with high-dose hemodiafiltration compared to those treated with high flux hemodialysis.

In comparison to regular hemodialysis, high-dose hemodiafiltration may be advantageous for individuals with kidney failure, according to many studies. Additional information is required, nevertheless, due to the limitations of the published research.


STUDY METHODS

The research, which was released on June 16, 2023, in the New England Journal of Medicine, is the first randomized experiment to evaluate the two therapies on a global scale. The results suggest that expanding the use of high-dose hemodiafiltration would be clearly advantageous for patients.

A serious global health issue, chronic kidney disease is thought to impact 830 million people worldwide. Dialysis is used to clean the blood by eliminating waste products, a task ordinarily carried out by the kidneys themselves, when they are no longer able to complete their job. There are over four million dialysis patients globally.


The most popular type of dialysis used to treat kidney failure is hemodialysis. Even while it has become better over time, it still does a poor job of clearing out bigger molecules from the blood. A more recent technique, hemodiafiltration, which can remove bigger molecules, is not appropriate for all patients since it needs a greater blood flow rate to function. Previous research has not been able to establish with absolute certainty which approach is the most efficient one.

The researchers who conducted the study recommended a realistic, international, high-flux hemodialysis for at least three months before high-flux hemodialysis randomized controlled trial including patients with renal failure. 

In addition to being able to complete patient-reported outcome assessments, all of the patients were determined to be eligible for a convection volume of at least 23 liters per session (as needed for high-dose hemodiafiltration). High-dose hemodiafiltration was the patients' designated treatment, while high-flux hemodialysis as usual was their other option. Death, regardless of the cause, was the main result. 

Key secondary outcomes were cause-specific mortality, an amalgam of fatal or nonfatal cardiovascular events, kidney transplantation, and recurring all-cause or infection-related hospitalizations.


STUDY RESULTS

1360 patients in total were randomly assigned to either high-dose hemodiafiltration (683) or high-flux hemodialysis (677), respectively. The interquartile range of the follow-up's median was 27 to 38 months. The hemodiafiltration group's mean convection volume over the course of the study was 25.3 liters per session. Death from any cause occurred in 148 patients (21.9%) and 118 patients (17.3%) in the hemodialysis and hemodiafiltration groups, respectively (hazard ratio, 0.77; 95% confidence range, 0.65 to 0.93).

High-dose hemodiafiltration reduced the risk of mortality from any cause in patients receiving kidney replacement treatment for renal failure compared to traditional high-flux hemodialysis. 

Additionally, the absolute survival benefit may have differed among the patients in the hemodiafiltration group. Hemodiafiltration had previously been shown to improve survival in individuals who were younger, did not have diabetes or cardiovascular disease, and had higher blood creatinine and albumin levels. 

A more accurate investigation of treatment effects across subgroups might be possible by updating the hemodiafiltration-pooling project with individual-participant data from the current study and from other studies (such as the High-Volume Hemodiafiltration vs. High-Flux Hemodialysis Registry [H4RT]). Results from 9 trials, together with those from a number of additional trials and sizable observational studies, tend to suggest that the safety of hemodiafiltration was satisfactory as long as sanitary and microbiologic guidelines are strictly followed.


Conclusion

While hemodialysis is a common kind of therapy in most states, hemofiltration is less common in some and completely absent in others, such as the US. Both methods can be performed by the majority of contemporary dialysis equipment, which would make the transition to hemofiltration quite simple.

Senior author of the Study Professor Andrew Davenport (UCL Medicine and the Royal Free Hospital) said that throughout his career, he has seen innovative therapies for a variety of illnesses, from cancer to diabetes, but they haven't seen the same advancements in the treatment of chronic kidney disease. 

This study demonstrates the benefits for patients of using hemodiafiltration to target various molecules. For kidney disease patients and their families, this is the first significant advancement in many years.