2023-06-20 10:41:00
Hemodiafiltration results in a higher survival in patients with renal failure compared to regular hemodialysis. Nephrologist Peter Blankestijn (UMCU) and others show this in The New England Journal of Medicine.
Hemodiafiltration is a form of dialysis in which you filter the blood not only via diffusion but also via a pressure difference and is therefore a combination of hemodialysis and hemofiltration. Hemodiafiltration filters out more waste products than hemodialysis. Nevertheless, the latter is still the most commonly used treatment for the approximately 6,200 kidney patients in the Netherlands who depend on dialysis. The reasons for this are that with hemodiafiltration patients must be able to handle the higher pumping speeds and have good vascular access. Previous trials have so far been unable to provide a definitive answer on the added value of hemodiafiltration in terms of survival.
Blankestijn et al. therefore conducted an open-label RCT in which 61 centers in eight European countries, including the Netherlands, participated; the so-called Convince study. Between the end of 2018 and the beginning of 2021, 1360 patients were enrolled who had renal failure (grade V renal insufficiency), who had undergone hemodialysis for at least three months and who were all suitable for high-dose hemodiafiltration. Of these, 683 patients received high-dose hemodiafiltration and 677 high flux hemodialysis. Unlike low flux hemodialysis, the dialysis membrane in high flux hemodialysis is more permeable and can filter larger substances.
Survival
The researchers followed the patients for 30 months. In the group undergoing hemodiafiltration, 118 patients (17.3%) died, in the group undergoing hemodialysis 148 patients died (21.9%, hazard ratio 0.77, p=0.005). If patients already had cardiovascular problems at the start of the study (slightly less than half of the patients in both groups) or diabetes mellitus (approximately 35% in both groups), there was no difference in survival between the group with hemodiafiltration and those with hemodiafiltration. hemodialysis. If they did not yet have this diagnosis, there was a higher mortality in the hemodialysis group: In the hemodiafiltration and hemodialysis groups, 11 versus 18 percent of the patients without a history of cardiovascular disease and 12 versus 18 percent of the non-diabetics died, respectively .
Blankestijn explains on the UMCU website: ‘The results of our research are an important step forward in the treatment of patients with renal failure. It is expected that hemodiafiltration will be used much more extensively worldwide from now on. Perhaps it will replace hemodialysis as the standard.’
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