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Kidney Week

Abstract: TH-PO1133

Real-World Effectiveness of Hemodialysis Modalities

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Zhang, Yan, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Winter, Anke, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Carioni, Paola, Fresenius Medical Care AG & Co KGaA, Milan, Italy
  • Alejos, Belen, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Usvyat, Len A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care AG & Co KGaA, Bad Homburg, Hessen, Germany
Background

Results from the CONVINCE clinical trial suggest a 23% mortality risk reduction among patients receiving hemodiafiltration (HDF). We assessed the real-world effectiveness of HD modality (HDF versus hemodialysis (HD)) in a large, unselected patient population treated prior to and during pandemic years.

Methods

We included EuCliD data from 85,222 adult HD patients who were treated in EMEA NephroCare Clinics between 2019 and 2022 in the analyses. Cox proportional hazard models with HD modality and COVID-19 status as time-varying covariates and adjusted for multiple confounders were used to estimate all-cause mortality. Subgroup analyses were performed for age, patient status (incident/prevalent), COVID-19 status, diabetes, circulatory disease, and dialysis vintage.

Results

The mean age of the population was 63.2 years and 60% were male. During the median follow-up of 22.6 months, a documented COVID-19 infection was associated with an overall 2.4-fold increased all-cause mortality risk. Compared with HD patients, those treated with HDF had an adjusted hazard ratio for all-cause mortality of 0.78 (95% CI, 0.76-0.80). The pattern of a beneficial effect of HDF was consistently observed among all subgroups. Patients with a documented COVID-19 infection and those with a history of circulatory disease had a slightly more reduced effect estimate in subgroup analyses (Figure 1).

Conclusion

Our results suggest that hemodiafiltration has a beneficial effect on all-cause mortality in a large, unselected patient population and across patient subgroups that were treated in real-world settings. Our observational study complements evidence generated by the CONVINCE trial and adds to the growing body of real-world evidence on hemodiafiltration.