Abstract: FR-OR20
Mortality Risk on Hemodiafiltration Compared with High-Flux Hemodialysis: Real-World Evidence from a Large Brazilian Cohort
Session Information
- Dialysis: What's New in Techniques and Management
October 25, 2024 | Location: Room 8, Convention Center
Abstract Time: 04:40 PM - 04:50 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Canziani, Maria Eugenia F., Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, SP, Brazil
- Strogoff-de-Matos, Jorge P., Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
- Barra, Ana Beatriz Lesqueves, Fresenius Medical Care AG, Rio de Janeiro, Brazil
Background
Patients undergoing online hemodiafiltration (HDF) have been associated with better survival compared to those on high-flux hemodialysis (HD). Recently, the use of HDF has grown markedly in Brazil, but there is no robust real-world Brazilian study on the impact of this dialysis modality on patient’s outcomes. Objective: To compare the mortality risk in patients treated with HDF and high-flux HD in a large cohort population in Brazil.
Methods
This is an observational cohort study of all adult patients on maintenance dialysis (HD and HDF) at 29 facilities in Brazil from January 1, 2022, to December 31, 2023.
Results
A total of 8,391 unselected patients were included in the study: 6,787 on high-flux HD, 1,604 on HDF only, and 1,222 who migrated from high-flux HD to HDF during the follow-up period, making a total of 2,826 patients on HDF. Patients on HDF, compared to those on HD, were older (66 vs. 62 years; p < 0.001) and with a higher prevalence of diabetes (36.8% vs. 32.6%; p < 0.001). Most patients reached the target dialysis dose along the follow-up period, with a median of 25.3 (interquartile range [IQR] 20.9 – 28.4) liters of convection volume per session for HDF patients, and a single-pool Kt/V of 1.58 (IQR 1.36 – 1.81) per session for those undergoing HD. The median follow-up was 14,3 ± 8,8 months for the patients in the two treatment groups. Death from any cause occurred in 1.243 patients, 311 in the HDF, and 932 in the HD group. The two-year survival rates in these groups were 81.2% and 77.9%, respectively (p < 0.001). In the analysis of the subdistribution proportional hazard ratio (sHR) by the Fine-Gray model, including the adjustment for competing outcomes and time-varying covariates, a significant reduction in the death risk was found for patients on HDF (sHR 0.75; 95% confidence interval [CI] 0.65 to 0.86]). In the analysis of subgroups, the reduction of death risk associated with HDF was more pronounced for patients aged < 65 (sHR, 0.49; 95% CI, 0.38 to 0.65) than for those aged 65 or more (sHR, 0.82; 95% CI, 0.71 to 0.95).
Conclusion
Online HDF was associated with a lower risk of death than conventional high-flux HD in a large cohort of patients in Brazil.