Abstract: TH-PO0854
Total Body Water-Standardized Convection Volume and Survival in Patients on Hemodiafiltration
Session Information
- Dialysis: Prescription, Physiology, and Treatment Optimization
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Zhang, Yan, Renal Research Institute, New York, New York, United States
- Ficociello, Linda, Renal Research Institute, New York, New York, United States
- Usvyat, Len A., Renal Research Institute, New York, New York, United States
- Stuard, Stefano, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy
Background
Higher convection volume (CV) during hemodiafiltration (HDF) has been associated with improved survival. However, achieved CV is strongly related to body composition. In our prior analysis, achieved CV was independently associated with lean tissue index, but not fat tissue index, suggesting that CV primarily reflects lean body mass and total body water (TBW). We therefore evaluated the dose-response association of TBW-standardized (TBW-s) CV with mortality in HDF patients.
Methods
We conducted a retrospective cohort study including 51,199 patients treated from 2019 to 2022 in Fresenius Medical Care NephroCare Clinics. Clinical and treatment data, including body composition measurements obtained using body composition monitoring (BCM), were extracted from the European Clinical Database. Association of achieved CV and TBW-s CV with all-cause mortality was assessed by adjusted restricted cubic spline Cox regression models.
Results
Among 27,117 HDF patients, the median (IQR) of achieved and TBW-s CV (L) were 25.5 (23.7−27.4) and 25.1 (21.9−27.4), respectively, over the 6-month baseline. Compared with hemodialysis (HD) patients (n=24,082), TBW-s CV demonstrated a consistent monotonic inverse dose-response association with mortality (Figure 1). In contrast, achieved CV exhibited a nonlinear association with mortality, characterized by a monotonic reduction in mortality risk only at higher CV, whereas limited risk separation at lower achieved CV levels.
Conclusion
Our findings do not diminish the physiological relevance of delivered absolute CV but suggests that normalization to TBW may reduce body composition–related heterogeneity and provide a more physiologically comparable estimate of effective convective dose across patients. This approach may facilitate a transition from fixed CV targets toward a more physiologically individualized HDF strategy.