London [UK], June 19 : According to a recent study from the CONVINCE collaboration led by University Medical Centre Utrecht, mortality in patients with kidney failure was shown to be 23 per cent lower among those treated with high dosage haemodiafiltration compared to those treated with high flux haemodialysis.
The findings of the study published in the New England Journal of Medicine, is the first randomised experiment to evaluate the two therapies on a global scale. The results suggest that expanding the use of high-dosage hemofiltration might be beneficial for patients.
A serious global health issue, chronic kidney disease is thought to impact 830 million people worldwide. Dialysis is used to clean the blood by eliminating waste products, a task ordinarily carried out by the kidneys themselves, when they are no longer able to complete their job. There are over four million dialysis patients globally.
Haemodialysis is the most common form of dialysis used in the treatment for kidney failure. Though it has improved over the years, it is not good at removing larger molecules from the blood. Haemodiafiltration is a newer technology that can remove larger molecules, but it is not suitable for all patients due to the fact that it requires a higher blood flow rate to be effective. Previous studies have failed to conclusively prove that one method is more effective than the other.
The CONVINCE trial has been led by researchers at UMC Utrecht together with collaborators at University College London (UCL), Charite Universitatsmedizin Berlin, University of Bari, The George Institute for Global Health and Imperial College London, along with dialysis providers Fresenius Medical Care, Diaverum and B. Braun Avitum. It is the first multinational, randomised trial to compare high-flux haemodialysis and high-dose haemodiafiltration, with the aim of clarifying which method is superior.
At 61 centres in eight European countries, a total of 1,360 patients were randomised, with 683 treated with high-dose haemodiafiltration and 677 treated with high-flux haemodialysis three times a week.
During a median follow-up of 30 months, all-cause mortality was 21.9% among those treated with high-flux haemodialysis, compared to 17.3% for those treated with high-volume haemodiafiltration. This 4.6% difference represents a 23% reduction in the risk of death.
Lead investigator, Professor Peter Blankestijn (UMC Utrecht), said: "Our results show clear survival benefits for using haemodiafiltration over haemodialysis to treat kidney failure, akin to a 23% reduction in all-cause mortality. My hope is that haemodiafiltration can become the new standard."
Professor Matthias Rose (Charite University, Berlin), a senior author of the study and expert in patient-reported outcomes, said: "In addition to clinical events, patient perception and thus reported outcomes are very important. We are currently performing in-depth analyses of the extensive data on patient-reported outcomes that have been collected in the CONVINCE study, with results expected later this year."
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