Abstract: FR-PO0465
Hemodiafiltration Is Associated with Lower Mortality in Patients with CKD 5D: Preliminary Results from a Brazilian Real-World Multicenter Study
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Dantas, Cássia Lopes, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Vieira, Tales Dantas, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Alves, Camila Albuquerque, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Kojima, Christiane, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Barbosa, Bianca Vitória dos Santos, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Silva, Maryanne Zilli Canedo, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Mazzali, Marilda, Universidade Estadual de Campinas, Campinas, SP, Brazil
- Rocha, Érica Pires da, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Modelli de Andrade, Luis Gustavo, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Ponce, Daniela, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
Background
The choice of dialysis modality impacts clinical outcomes in chronic kidney disease (CKD) stage 5D, particularly mortality, hospitalizations, and infections. Hemodiafiltration (HDF) removes middle-molecular-weight uremic toxins, potentially reducing inflammation and improving prognosis. However, comparative studies between conventional hemodialysis (HD), peritoneal dialysis (PD), and HDF are limited in Latin America and lack validation in real-world populations. Objective: to evaluate the survival rates of patients undergoing one of three dialysis modalities
Methods
This retrospective multicenter cohort study included three centers in Brazil and encompassed patients with stage 5 CKD who began renal replacement therapy between January 2019 and September 2024. Participants were monitored for at least 24 months or until a defined outcome occurred. Patients were categorized based on their initial dialysis method (HD, PD, or HDF). Data on sociodemographic, clinical, laboratory, and outcomes were extracted from electronic medical records. Survival was analyzed using Kaplan-Meier curves and Cox proportional hazards models adjusted for age, income, education, comorbidities, and center.
Results
A total of 282 patients were included: 129 received HD, 70 received PD, and 83 received HDF. Median age was 61 years; 61% were male, and 68% identified as white. Diabetes was present in 52%, and cardiovascular diseases in 28%. The groups were similar in age and underlying conditions but differed in income and education, both higher among HDF patients. The overall mortality rate was 20%, with rates of 27% in HD, 24% in PD, and only 4.8% in HDF. The estimated 36-month survival rates were 71% for HD, 70% for PD, and 95% for HDF (p < 0.001). In multivariate analysis, HDF was linked to a lower risk of death compared to HD (HR = 0.15; 95% CI: 0.04–0.61; p < 0.001), even after excluding early deaths within the first three months.
Conclusion
In this multicenter study, HDF was associated with improved survival compared to HD and PD modalities. These findings highlight the benefits of HDF and emphasize the need to increase its accessibility within Brazil’s public healthcare system.