19 Jun 2023 • High-dose hemodiafiltration (HDF) produced substantially better survival compared with conventional, high-flux hemodialysis in people with end-stage kidney disease (ESKD). The results show that high-dose HDF, with a convection volume of greater than 23 L/session, improved overall survival by 23% compared with hemodialysis, these results were simultaneously published online in the New England Journal of Medicine.

The CONVINCE Trial

• A total of 1360 patients underwent randomization: 683 to receive high-dose hemodiafiltration and 677 to receive high-flux hemodialysis for a median of 30 months
• Death from any cause occurred in 118 patients (17.3%) in the hemodiafiltration group and in 148 patients (21.9%) in the hemodialysis group
• In patients with kidney failure resulting in kidney-replacement therapy, the use of high-dose hemodiafiltration(HDF) resulted in a lower risk of death from any cause than conventional high-flux hemodialysis.
• Previous studies have failed to conclusively prove that high-dose hemodiafiltration is more effective than conventional hemodialysis, but these new findings have changed this.

Although hemodialysis — the most common form of dialysis used in the treatment of kidney failure — has improved over the years, it is not good at removing larger molecules from the blood, relying as it does on membrane diffusion, the passage of uremic toxin molecules across a membrane that is driven by concentration differences. Hemodiafiltration is a newer technology that relies not only on diffusion but also introduces convection, allowing for more efficient removal of larger and medium-sized water-soluble molecules.

Source: NEJM | Read full story