Hemodiafiltration reduces all-cause mortality in people with kidney failure: Lancet

A new study published in The Lancet journal showed that hemodiafiltration lowers mortality associated with kidney failure compared to hemodialysis, with dose-dependent advantages. Within 5 years of the first dialysis demand, kidney failure is linked to a death risk of almost 50%. Estimates of survival may increase with convection-based hemodialysis therapies, which eliminate a wider range of uremic chemicals than diffusive therapy.

According to randomized clinical research, individuals with kidney failure who get high-dose hemodiafiltration instead of traditional high-flux hemodialysis have a 23% decreased chance of dying. However, it is yet unknown if treatment effects vary among subgroups, if there is a dose-response connection with convection volume, and how it affects cause-specific mortality.

Thus, Robin Vernooij and colleagues presented an overview of the available data from randomized controlled studies comparing hemodiafiltration and hemodialysis that were intended to evaluate all-cause mortality in patients with renal failure is the goal of this individual patient data meta-analysis. This study wanted to offer more exact estimates of the impact of hemodiafiltration vs hemodialysis across multiple subgroups, to measure cause-specific mortality, and to provide light on the ongoing link between attained convection volume and mortality risks.

This research looked for randomized controlled trials that compared online hemodialysis vs hemodiafiltration intended to quantify mortality outcomes in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials published since the creation of database on July 17, 2024. All-cause mortality was the main result. Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals. 

This analysis included 5 studies with a total of 4153 patients (2070 undergoing hemodialysis and 2083 receiving hemodiafiltration). When compared to 559 patients (27·0%) treated with hemodialysis, 477 patients (23·3%) had all-cause death after a median follow-up of 30 months (IQR 24–36) (hazard ratio 0·84 [95% CI 0·74–0·95]).

Also, there was no indication of a difference in impact between subgroups. It was evident that the convection volume and mortality risk had a graded relationship, with the mortality risk decreasing as the volume grew. Overall, online hemodiafiltration lowers all-cause mortality in patients with renal failure when compared to hemodialysis. 

Source:

Vernooij, R. W. M., Hockham, C., Strippoli, G., Green, S., Hegbrant, J., Davenport, A., Barth, C., Canaud, B., Woodward, M., Blankestijn, P. J., Bots, M. L., Blankestijn, P. J., Vernooij, R. W., Hockham, C., Strippoli, G. F., Canaud, B., Hegbrant, J., Barth, C., Cromm, K., … Woodward, M. (2024). Haemodiafiltration versus haemodialysis for kidney failure: an individual patient data meta-analysis of randomised controlled trials. In The Lancet (Vol. 404, Issue 10464, pp. 1742–1749). Elsevier BV. https://doi.org/10.1016/s0140-6736(24)01859-2