Hemodialysis Modality and Mortality Outcomes among Incident Dialysis Patients: An International Cohort Study Comparing High-Volume Hemodiafiltration and Hemodialysis.
Among more than 18,000 patients in their first year of dialysis, those treated mostly with high-volume haemodiafiltration had about 20% lower death rates than those on standard haemodialysis, and about 29% fewer deaths from heart disease.
Background
Evidence for a survival benefit of haemodiafiltration over high-flux haemodialysis has come largely from studies of prevalent kidney failure patients with longer dialysis exposure. The effect in incident patients — those newly starting dialysis — has been less well understood.
Study design
The investigators analysed 18,515 incident patients (dialysis vintage under 3 months) treated between 2019 and 2022 at Fresenius Medical Care NephroCare clinics. Patients were classified as HDF or haemodialysis based on their predominant modality during the first year (at least 75% of sessions), follow-up was limited to 2 years, and Cox models with inverse probability of treatment weighting estimated all-cause and cardiovascular mortality risk.
Key findings
Over a median follow-up of 15.7 months (IQR 6.4-24.0), HDF was associated with lower all-cause mortality than haemodialysis (11.7 versus 15.6 per 100 person-years; hazard ratio 0.80; 95% CI 0.75-0.86) and lower cardiovascular mortality (4.1 versus 6.7 per 100 person-years; hazard ratio 0.71; 95% CI 0.63-0.80). Associations were consistent across demographic and clinical subgroups, and baseline characteristics were comparable after weighting.
Clinical implications
These real-world data support considering HDF from the point of dialysis initiation rather than reserving it for established patients, while recognising that observational designs cannot fully separate modality effect from patient selection.
Category
Research
Source
Clinical Journal of the American Society of Nephrology
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