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Abstract: FR-PO455

Improved Survival with High-Volume Hemodiafiltration in Argentina: A Propensity Score-Matched Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ferder, Marcelo D., Fresenius Medical Care Latin America, Buenos Aires, Argentina
  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Puddu, Marcelo H., Fresenius Medical Care Argentina, buenos Aires, Argentina
  • Marelli, Cristina, Fresenius Medical Care Latin America, Buenos Aires, Argentina
  • Guinsburg, Adrian M., Fresenius Medical Care Latin America, Buenos Aires, Argentina
Background

While hemodialysis (HD) is the current standard of care, hemodiafiltration (HDF) adds high convective volume to remove middle molecules. We compared all-cause mortality in Fresenius Medical Care Argentina patients treated with either HDF or high-flux HD.

Methods

Data were extracted from Fresenius EuCliD® database and comprise treatments between 11/2011 and 05/2018. Pts were divided patients into those treated with HD (control group), high-volume (HV) HDF (>70% of treatments with >23 L substitution volume), and low-volume (LV) HDF (< 23 L substitution volume). The baseline period comprised 3 months before the HD-to-HDF switch, it was followed by 1 month washout period. Pts were for 1 year, death, or lost to follow-up. To minimize bias by indication, HDF pts were propensity score matched to HD pts by age, gender, diabetes, vintage, fluid status (determined by bioimpedance), vascular access, systolic blood pressure, phosphate, and albumin.

Results

We selected 12,911 pts from 73 centers (11,111 HD; 1,800 HDF). Propensity score matching resulted in 537 HD and 545 HDF patients (Table 1). Kaplan-Meier analysis showed a survival benefit of HV-HDF vs. HD (11.46 vs 22.5 deaths/100 pt-years, p=0.039, figure 1), but not for LV-HDF (23.4 vs 22.5 deaths/100 pt-years).

Conclusion

Within the known limitations of observational trials (patient selection bias, residual confounding) our propensity score matched multicenter study shows a survival benefit of HV-HDF, but not LV-HDF, over HD in Argentinian patients.