Mortality on Hemodiafiltration Compared to High-Flux Hemodialysis: A Brazilian Cohort Study
In a real-world cohort of more than 8,000 Brazilian dialysis patients, those treated with haemodiafiltration had a 27% lower adjusted risk of death than those on high-flux haemodialysis, extending trial findings to an unselected, middle-income-country population.
Background
Haemodiafiltration (HDF) has been linked to better survival than high-flux haemodialysis (HD) in randomized trials conducted mainly in high-income countries, but real-world data from unselected populations in middle-income settings have been scarce.
Study design
This observational cohort included all adult maintenance dialysis patients at 29 Brazilian facilities between January 2022 and December 2023—6,787 on high-flux HD and 2,836 on HDF (1,222 of whom migrated from HD to HDF). Dialysis modality was treated as a time-updated exposure in multivariable Cox models for all-cause and cause-specific mortality.
Key findings
Two-year survival was 81.2% with HDF versus 77.9% with HD (P<0.001). The adjusted death risk was significantly lower with HDF (HR 0.73; 95% CI 0.63–0.85), with a reduction in cardiovascular but not infection-related mortality. The effect was more pronounced in patients under 65 (HR 0.56; 95% CI 0.42–0.77).
Clinical implications
The consistency of the survival advantage across subgroups, in a routine-care population, strengthens the case for HDF where convection volumes can be delivered—while the retrospective design and short follow-up are acknowledged limitations.
Category
Research
Source
American Journal of Kidney Diseases
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