High dose hemodiafiltration may reduce mortality in kidney transplant cases: NEJM

A new study published in The New England Journal of Medicine suggests that 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.

According to several studies, high-dose hemodiafiltration may be more advantageous for individuals with renal failure than traditional hemodialysis. However, more information is required due to the shortcomings of the numerous published investigations. The purpose of this study, which was carried out by Peter Blankestijn and colleagues, was to evaluate the impact of hemodiafiltration on mortality in renal failure.

Patients with renal failure who had been receiving high-flux hemodialysis for at least three months participated in a pragmatic, randomized, international, controlled study. All of the patients met the criteria for high-dose hemodiafiltration (convection volume of at least 23 liters each session) and were able to complete patient-reported outcome evaluations. The patients were given the option of continuing with the standard high-flux hemodialysis or receiving high-dose hemodiafiltration. Death from any cause was the main result. The composite of fatal or nonfatal cardiovascular events, kidney transplantation, and repeated all-cause or infection-related hospitalizations were significant secondary outcomes.

The key findings of this study were:

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 experiment was 25.3 litres each 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).

The researchers suggested that a combined comparison of the trial's results with those from other studies would enable a more focused investigation of the advantages of hemodiafiltration in particular subgroups. The safety of hemodiafiltration was satisfactory, at least according to all the experiments, as long as sanitary and microbiological regulations are strictly followed.

Reference:

Blankestijn, P. J., Vernooij, R. W. M., Hockham, C., Strippoli, G. F. M., Canaud, B., Hegbrant, J., Barth, C., Covic, A., Cromm, K., Cucui, A., Davenport, A., Rose, M., Török, M., Woodward, M., & Bots, M. L. (2023). Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2304820