Abstract: FR-OR111
Haemodiafiltration or Haemodialysis for Kidney Failure: Totality of Evidence Based on Individual Patient Data Meta-Analysis from Randomised Controlled Trials
Session Information
- Late-Breaking Science Orals - 1
October 25, 2024 | Location: Room 6C, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Blankestijn, Peter J., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
- Vernooij, Robin W.m., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
- Bots, Michiel L., Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
Group or Team Name
- The CONVINCE Scientific Committee and the HDF Pooling Project Investigators.
Background
Recently a 23% lower mortality risk was reported in patients with kidney failure treated with high-dose haemodiafiltration compared to conventional high-flux haemodialysis (NEJM 2023). Nevertheless, it remains unclear whether treatment effects differ across subgroups, whether there is a dose-response relationship with convection volume, and the effects on cause-specific mortality. The goal of this individual patient data meta-analysis was to analyse the effect of haemodiafiltration on death from any cause compared with standard haemodialysis.
Methods
We searched MEDLINE, Embase, and CENTRAL from inception to until July 2024 for all randomised controlled trials, comparing online haemodiafiltration with haemodialysis, that were designed to measure mortality outcomes. The primary outcome was all-cause mortality. Hazard ratios were generated using Cox proportional hazards regression models reporting hazard ratios (HR) and 95% confidence intervals (95% CI). Subgroup analyses on predefined patient characteristics and dose-response analyses, using natural splines, on convection volume were performed (PROSPERO registration: CRD42024511514).
Results
Five trials (CONTRAST, ESHOL, Turkish HDF study, French HDF study, CONVINCE, n=4153 patients; 2070 receiving haemodialysis, 2083 receiving haemodiafiltration) proved eligible. After a median follow-up of 30 months (Q1-Q3: 24-36), all-cause mortality occurred in 477 patients (23.3%) treated with haemodiafiltration compared with in 558 patients (27.2%) treated with haemodialysis (HR: 0.84; 95%CI: 0.74 to 0.95). There was no evidence for a differential effect across subgroups. A graded relationship between convection volume and mortality risk was apparent: as the convection volume increases, the mortality risk decreases.
Conclusion
Online haemodiafiltration reduces all-cause mortality and cardiovascular mortality compared with haemodialysis in patients with kidney failure. Results do not differ across patient and treatment characteristics and the risk reduction appears dose-dependent.
Funding
- Government Support - Non-U.S.