Real-world effectiveness of hemodialysis modalities: a retrospective cohort study
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...
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2025-01-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-024-03934-y |
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| author | Yan Zhang Anke Winter Belén Alejos Ferreras Paola Carioni Otto Arkossy Michael Anger Robert Kossmann Len A. Usvyat Stefano Stuard Franklin W. Maddux |
| author_facet | Yan Zhang Anke Winter Belén Alejos Ferreras Paola Carioni Otto Arkossy Michael Anger Robert Kossmann Len A. Usvyat Stefano Stuard Franklin W. Maddux |
| author_sort | Yan Zhang |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-6cae3b519eab4201a53a067984cf1e63 |
| institution | Kabale University |
| issn | 1471-2369 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Nephrology |
| spelling | doaj-art-6cae3b519eab4201a53a067984cf1e632025-01-12T12:11:34ZengBMCBMC Nephrology1471-23692025-01-0126111110.1186/s12882-024-03934-yReal-world effectiveness of hemodialysis modalities: a retrospective cohort studyYan Zhang0Anke Winter1Belén Alejos Ferreras2Paola Carioni3Otto Arkossy4Michael Anger5Robert Kossmann6Len A. Usvyat7Stefano Stuard8Franklin W. Maddux9Fresenius Medical Care Deutschland GmbHFresenius Medical Care Deutschland GmbHFresenius Medical Care Deutschland GmbHFresenius Medical Care Italia S.p.AFresenius Medical Care Deutschland GmbHFresenius Medical Care Holdings IncFresenius Medical Care Holdings IncFresenius Medical Care Holdings IncFresenius Medical Care Deutschland GmbHFresenius Medical Care Deutschland GmbHAbstract 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.https://doi.org/10.1186/s12882-024-03934-yHemodiafiltrationHigh-flux hemodialysisMortalityCardiovascular mortalityKidney replacement therapy |
| spellingShingle | Yan Zhang Anke Winter Belén Alejos Ferreras Paola Carioni Otto Arkossy Michael Anger Robert Kossmann Len A. Usvyat Stefano Stuard Franklin W. Maddux Real-world effectiveness of hemodialysis modalities: a retrospective cohort study BMC Nephrology Hemodiafiltration High-flux hemodialysis Mortality Cardiovascular mortality Kidney replacement therapy |
| title | Real-world effectiveness of hemodialysis modalities: a retrospective cohort study |
| title_full | Real-world effectiveness of hemodialysis modalities: a retrospective cohort study |
| title_fullStr | Real-world effectiveness of hemodialysis modalities: a retrospective cohort study |
| title_full_unstemmed | Real-world effectiveness of hemodialysis modalities: a retrospective cohort study |
| title_short | Real-world effectiveness of hemodialysis modalities: a retrospective cohort study |
| title_sort | real world effectiveness of hemodialysis modalities a retrospective cohort study |
| topic | Hemodiafiltration High-flux hemodialysis Mortality Cardiovascular mortality Kidney replacement therapy |
| url | https://doi.org/10.1186/s12882-024-03934-y |
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