Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure.
The CONVINCE trial found that high-dose hemodiafiltration lowered the risk of death from any cause compared with conventional high-flux hemodialysis in patients able to achieve high convection volumes.
Background
Several studies suggested that patients with kidney failure may benefit from high-dose hemodiafiltration compared with standard hemodialysis, but limitations of those studies meant additional data were needed.
Study design
Pragmatic, multinational, randomized controlled trial in patients who had received high-flux hemodialysis for at least 3 months, were deemed candidates for a convection volume of at least 23 liters per session, and could complete patient-reported outcome assessments. Patients were assigned to high-dose hemodiafiltration or continued high-flux hemodialysis. The primary outcome was death from any cause.
Key findings
A total of 1360 patients were randomized (683 hemodiafiltration, 677 hemodialysis) with a median follow-up of 30 months. Mean convection volume in the hemodiafiltration group was 25.3 liters per session. Death from any cause occurred in 118 patients (17.3%) with hemodiafiltration and 148 (21.9%) with hemodialysis (hazard ratio 0.77; 95% CI, 0.65 to 0.93).
Clinical implications
For patients in whom high convection volumes are achievable, high-dose hemodiafiltration resulted in a lower risk of death from any cause than conventional high-flux hemodialysis.
Category
News
Source
The New England journal of medicine
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