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Kidney Week

Abstract: TH-PO1189

Which Patients Benefit the Most from Hemodiafiltration Compared with Hemodialysis? Prediction of Individualized Treatment Effects

Session Information

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 Study Group.
Background

High-dose haemodiafiltration (HDF) reduces all-cause death. No differences in treatment effects are found for specific patient populations when defined on a single characteristic in subgroup analyses. Yet, it is unclear to what extent individual patients, characterized by a combination of clinical characteristics, may benefit from HDF. This study aimed to develop and internally validate a treatment effect prediction model to determine which individual patients would benefit most from well dosed HDF, compared with haemodialysis (HD), in terms of survival.

Methods

Individual participant data from five randomized controlled trials (CONTRAST, ESHOL, Turkish HDF study, French HDF study, CONVINCE) comparing HDF with HD on all-cause mortality were used to derive a Royston-Parmar model for exploring the prediction of absolute treatment effect of HDF based on pre-specified patient and disease characteristics, notably age, sex, body mass index, diabetes mellitus, history of cardiovascular disease, creatinine levels, and c-reactive protein levels. Internal validation of the model was performed using internal-external cross validation.

Results

Among 4153 participants, with a median follow-up of 30 months (Q1-Q3: 24-36), death from any cause occurred in 558 patients (27.2%). The median predicted survival benefit of HDF compared with HD was 6.9 (Q1–Q3: 5.6–9.0) months, with a range of 2 to 42 months. Patients who were predicted to benefit most from HDF were younger, less likely to have diabetes or a cardiovascular history and had higher serum creatinine levels. Internal-external cross validation showed adequate discrimination and calibration.

Conclusion

All-cause mortality is reduced by HDF compared with HD in ESKD patients. Yet, the absolute survival benefit seems to considerably differ between individual patients. Our results suggest that the effects of HDF on absolute survival can be predicted using a combination of readily available patient and disease characteristics. This prediction model approach exemplifies the potential of prediction algorithms in supporting clinical decision-making for the choice of treatment options.

Funding

  • Government Support - Non-U.S.