Major Step Forward in Treating Patients With Kidney Failure

kidney failure patients treated with high-dose hemodiafiltration has 23% less mortality compared to those treated with high flux hemodialysis, according to new research from the CONVINCE consortium led by University Medical Center Utrecht. The findings published in the New England Journal of Medicine, are the first international, randomized trial to compare the two treatments. They indicate that wider use of high-dose haemodiafiltration would have clear benefits for patients.

Chronic kidney disease is a leading global health problem that affects an estimated 830 million people globally. When the kidneys can no longer do their job, dialysis is used to clean the blood by removing waste products, a function normally performed by the kidneys themselves. Around four million people are on dialysis worldwide.

Haemodialysis (1^✔ ✔Trusted Source
Recent advances in treatment of haemodialysis

Go to source) is the most common form of dialysis used in the treatment of kidney failure. Though it has improved over the years, it is not good at removing larger molecules from the blood.

Haemodiafiltration Can Become the New Standard for Kidney Transplant

Haemodiafiltration is a newer technology that can remove larger molecules, but it is not suitable for all patients since it requires a higher blood flow rate to be effective. Previous studies have failed to conclusively prove that one method is more effective than the other (2^✔ ✔Trusted Source
Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure

Go to source).

The CONVINCE trial has been led by researchers at UMC Utrecht together with collaborators at University College London (UCL), Charité Universitätsmedizin Berlin, University of Bari, The George Institute for Global Health and Imperial College London, along with dialysis providers Fresenius Medical Care, Diaverum and B. Braun Avitum.

At 61 centers in eight European countries, a total of 1,360 patients were randomized, with 683 treated with high-dose haemodiafiltration and 677 treated with high-flux hemodialysis three times a week.

During a median follow-up of 30 months, all-cause mortality was 21.9% among those treated with high-flux hemodialysis, compared to 17.3% for those treated with high-volume haemodiafiltration. This 4.6% difference represents a 23% reduction in the risk of death.

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These results show clear survival benefits for using haemodiafiltration over hemodialysis to treat kidney failure, akin to a 23% reduction in all-cause mortality.

While hemodialysis is a standard treatment in most countries, haemodiafiltration is less widely used in some places and is not used at all in places like the US (3^✔ ✔Trusted Source
Global prevalent use, trends and practices in haemodiafiltration

Go to source). Most modern dialysis machines can perform either method, which would make a switch to haemodiafiltration relatively easy.

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In addition to clinical events, patient perception and thus reported outcomes are very important. Researchers are currently performing in-depth analyses of the extensive data on patient-reported outcomes that have been collected in the CONVINCE study, with results expected later this year.

This study proves that targeting different molecules through haemodiafiltration has clear benefits for patients. This is the first major step forward in many years and is good news for kidney disease patients and their families.

References:

1. Recent advances in treatment of haemodialysis - (https://journals.sagepub.com/doi/10.1177/0141076820972669)
2. Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure - (https://www.nejm.org/doi/10.1056/NEJMoa2304820)
3. Global prevalent use, trends and practices in haemodiafiltration - (https://academic.oup.com/ndt/article/35/3/398/5320340?login=false)

Source-Eurekalert