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Kidney Week

Abstract: FR-PO0469

Eligibility of ANZDATA Registry Patients for the CONVINCE Randomized Trial

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chua, Su Jen, Mercy Hospital for Women, Heidelberg, Victoria, Australia
  • Brown, Leanne, Griffith University, Brisbane, Queensland, Australia
  • Kairaitis, Lukas K., Blacktown & Mount Druitt Hospital, Blacktown, New South Wales, Australia
  • Krishnasamy, Rathika, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
  • See, Emily, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  • Semple, David, Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, Auckland, New Zealand
  • Toussaint, Nigel David, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  • Viecelli, Andrea K., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Polkinghorne, Kevan, Monash University, Melbourne, Victoria, Australia
  • Roberts, Matthew A., Eastern Health, Box Hill, Victoria, Australia

Group or Team Name

  • ANZDATA Haemodialysis Working Group.
Background

The CONVINCE randomized trial demonstrated reduced all-cause mortality in patients undergoing hemodiafiltration (HDF) compared to high-flux hemodialysis (HD). Given the CONVINCE trial included participants likely to achieve >23L convection volume in post-dilution mode, we aimed to determine what proportion of patients in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Registry could have been included.

Methods

We used ANZDATA Registry data from 2019-2023 to determine what proportion of adult hemodialysis patients were likely to achieve>23L convection volume and met the other eligibility criteria for the CONVINCE trial: 1) thrice weekly treatment, 2) blood flow >300mL/min, 3) no living donor kidney transplant anticipated within 6 months, 4) life expectancy >3 months.

Results

Of 21,264 patients receiving HD/HDF in Australia and New Zealand from 2019-2023, 6557 (30.8%) would have been eligible for the CONVINCE Study. Reasons for ineligibility were: <thrice weekly treatment (n=2061), blood flow ≤300mL/min (n=7315), living donor kidney transplant within 6 months (n=557), life expectancy <3 months (n=4193). Eligible participants were more likely to commence dialysis with native arteriovenous fistula (52% vs 39%, p<0.001). There was no difference in age, mortality and comorbidities in eligible versus ineligible participants.

Conclusion

Using real-world data, our analysis suggests that the CONVINCE trial findings could only be applied to one-third of patients undergoing HD/HDF in Australia and New Zealand. The major reason for exclusion was insufficient blood flow rate.

Table 1: Characteristics for patients eligible for CONVINCE versus not eligible
Patient characteristics CONVINCE Ineligible (n=14707)CONVINCE Eligible (n=6557)t-test
Center characteristics at entry (%)Major city
Regional
Remote
9304 (77.8)
2338 (19.6)
310 (2.6)
4384 (79.8)
866 (15.8)
241 (4.4)
<0.001
Gender (%)Female
Intersex
Male
5949 (40.5)
0 (0.0)
8758 (59.5)
2335 (35.6)
1 (0.0)
4221 (64.4)
<0.001
Cause of ESKD (%)Diabetic kidney disease
Familial kidney diseases
Glomerular disease
Hypertension
Tubulointerstitial disease
Other
6317 (43.5)
890 (6.1)
2564 (17.7)
1697 (11.7)
1194 (8.2)
1859 (12.6)
2814 (43.3)
448 (6.9)
1244 (19.1)
760 (11.7)
491 (7.6)
746 (11.4)
0.001
Smoking status (%)Current
Former
Never
2006 (13.9)
5245 (36.4)
7152 (49.6)
815 (12.7)
2329 (36.3)
3259 (50.8)
0.049
Age (mean (SD)) 61.29 (14.73)61.40 (14.46)0.604
Diabetes status (%)No diabetes
Type 1
Type 2 - Insulin
Type 2 - No Insulin
6123 (42.0)
650 (4.5)
3860 (26.5)
3939 (27.0)
2742 (42.0)
262 (4.0)
1727 (26.4)
1803 (27.6)
0.448
Dialysis vintage (days) (mean (SD)) 634.38 (1251.15)885.77 (1392.81)<0.001
Vascular access (%)Native
Non Tunnel CV Catheter
Synthetic
Tunnel CV Catheter
5438 (39.3)
1230 (8.9)
159 (1.1)
7010 (50.7)
2952 (51.6)
383 (6.7)
70 (1.2)
2313 (40.5)
<0.001
Cause of death (%)Cancer
Cardiovascular
Infection
Not reported
Other
Withdrawal
124 (3.0)
1829 (44.5)
502 (12.2)
211 (5.1)
1035 (25.2)
412 (10.0)
69 (3.3)
907 (42.9)
253 (12.0)
86 (4.1)
564 (26.7)
237 (11.2)
0.181

Keywords: CV = central venous; ESKD = end stage kidney disease

Digital Object Identifier (DOI)