Abstract: SA-PO0350
Hemodiafiltration and Peritoneal Dialysis Associated with Lower Hospitalization Rates in Patients with Stage 5 CKD: Partial Results from a Brazilian Multicenter Real-World Study
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Vieira, Tales Dantas, Universidade Estadual Paulista Julio de Mesquita Filho, São Paulo, SP, Brazil
- Dantas, Cássia Lopes, 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
- Rocha, Érica Pires da, 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 Faculdade de Ciencias Medicas, Campinas, 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
Group or Team Name
- Nefrostar Osasco.
Background
Chronic kidney disease (CKD) stage 5D under renal replacement therapy (RRT) includes hemodialysis (HD), peritoneal dialysis (PD), and hemodiafiltration (HDF). The dialysis method can affect outcomes like hospitalizations, infections, and mortality. HDF offers better removal of medium-weight uremic toxins, which may lower inflammation, improve symptoms, and reduce complications. However, comparative data from Latin America are limited and lack validation in diverse populations.
Methods
A retrospective multicenter cohort study was conducted in Brazil (3 centers), including CKD stage 5D patients who started RRT between January 2019 and September 2024. Patients were followed for at least 24 months or until a defined outcome and classified by initial dialysis modality (HD, PD, or HDF). Exclusion criteria were active cancer, palliative care, pregnancy, and early modality switch. Data from electronic medical records included demographic, clinical, and laboratory information, as well as hospitalizations. Only patients with defined outcomes (death, transplant, modality switch, recovery, transfer, or continued therapy) were analyzed. Continuous variables were expressed as median and interquartile range. Hospitalizations were assessed using quasi-Poisson regression.
Results
A total of 282 patients were analyzed: 129 on HD, 70 on PD, and 83 on HDF. The median age was 61 years, with 61% being male. Most patients were white (68%) and had up to elementary education (46%). Diabetes was present in 52%, with more cardiovascular comorbidities in the PD (39%) and HDF (37%) groups. Median hospitalizations were 2.0 for HD and 1.0 for both PD and HDF (p < 0.001). In adjusted multivariate analysis, PD (HR = 0.44; 95% CI: 0.28–0.69; p = 0.001) and HDF (HR = 0.46; 95% CI: 0.22–0.91; p = 0.035) were linked to fewer hospitalizations than HD. Although higher education and income were associated with hospitalization differences, these were not significant after adjustment.
Conclusion
In this pragmatic study, HDF and PD were linked to reduced hospitalization risk, underscoring the potential advantages of HDF and the importance of its inclusion in public health systems.