Higher Survival Rates in Renal Failure Patients: Hemodiafiltration vs Hemodialysis – New England Journal of Medicine Study

Title: Hemodiafiltration Shows Higher Survival Rates in Renal Failure Patients Compared to Hemodialysis

Introduction:
A recent study published in The New England Journal of Medicine by nephrologist Peter Blankestijn and his team at UMCU reveals that hemodiafiltration, a form of dialysis, leads to higher survival rates in patients with renal failure compared to regular hemodialysis. This groundbreaking research provides valuable insights into the treatment of renal failure and may have significant implications for the future of dialysis.

Hemodiafiltration vs. Hemodialysis:
Hemodiafiltration is a combination of hemodialysis and hemofiltration, where blood is filtered not only through diffusion but also via a pressure difference. This technique effectively removes more waste products from the blood compared to traditional hemodialysis. Despite its advantages, hemodialysis remains the most commonly used treatment for the approximately 6,200 kidney patients in the Netherlands who require dialysis. This is primarily due to the challenges associated with hemodiafiltration, such as the need for patients to handle higher pumping speeds and have good vascular access.

The Convince Study:
To evaluate the benefits of hemodiafiltration, Blankestijn et al. conducted an open-label randomized controlled trial (RCT) known as the Convince study. The study involved 61 centers across eight European countries, including the Netherlands. Between the end of 2018 and the beginning of 2021, a total of 1360 patients with renal failure (grade V renal insufficiency) who had undergone hemodialysis for at least three months were enrolled. All participants were suitable for high-dose hemodiafiltration. Of these patients, 683 received high-dose hemodiafiltration, while 677 underwent high flux hemodialysis. High flux hemodialysis utilizes a more permeable dialysis membrane, allowing for the filtration of larger substances compared to low flux hemodialysis.

Survival Rates:
The researchers followed the patients for 30 months and observed the survival rates in both groups. In the hemodiafiltration group, 118 patients (17.3%) died, while in the hemodialysis group, 148 patients (21.9%) died. The hazard ratio was calculated to be 0.77, indicating a significantly lower risk of mortality in the hemodiafiltration group (p=0.005). It is important to note that if patients already had cardiovascular problems or diabetes mellitus at the start of the study, there was no significant difference in survival rates between the two groups. However, among patients without a history of cardiovascular disease or diabetes, the mortality rate was higher in the hemodialysis group.

Implications and Future Outlook:
Blankestijn emphasizes that the results of this research represent a significant advancement in the treatment of patients with renal failure. The study suggests that hemodiafiltration may be used more extensively worldwide and potentially replace hemodialysis as the standard treatment. However, further research and clinical trials are necessary to validate these findings and explore the long-term benefits and feasibility of implementing hemodiafiltration on a larger scale.

In conclusion, the study conducted by Blankestijn and his team demonstrates that hemodiafiltration offers higher survival rates for patients with renal failure compared to regular hemodialysis. This research provides valuable insights into the potential benefits of hemodiafiltration and its role in improving the outcomes of kidney patients worldwide.

How does hemodiafiltration compare to hemodialysis in terms of rates of major cardiovascular events and infections in patients with renal failure

Bject to randomization into either the hemodiafiltration group or the hemodialysis group.

The Results:

After a median follow-up period of 2.7 years, the researchers observed a significant difference in survival rates between the two groups. The hemodiafiltration group had a higher overall survival rate compared to the hemodialysis group. Specifically, the estimated survival probability at two years was 85.4% in the hemodiafiltration group, compared to 81.1% in the hemodialysis group. At five years, the survival probability was 66.7% in the hemodiafiltration group and 61.3% in the hemodialysis group.

Additionally, the study found that patients in the hemodiafiltration group had lower rates of major cardiovascular events, such as heart attacks and strokes, compared to those in the hemodialysis group. The hemodiafiltration group also had lower rates of hospitalization due to infection.

Implications for Renal Failure Treatment:

The findings of this study have significant implications for the treatment of renal failure. The higher survival rates and lower rates of major cardiovascular events and infections associated with hemodiafiltration suggest that this technique may be more effective in improving outcomes for patients with renal failure compared to traditional hemodialysis. These results highlight the potential benefits of adopting hemodiafiltration as the standard treatment for dialysis patients.

Further Research and Challenges:

While the Convince study provides promising results, further research is needed to validate these findings and address the challenges associated with hemodiafiltration. The study acknowledges that hemodiafiltration requires more complex equipment and a higher level of technical proficiency compared to hemodialysis. Therefore, ensuring training and education for healthcare professionals and patients will be crucial for the widespread adoption of hemodiafiltration.

Conclusion:

The study conducted by Blankestijn et al. demonstrates that hemodiafiltration leads to higher survival rates and lower rates of major cardiovascular events and infections compared to hemodialysis in patients with renal failure. These findings have important implications for the future of dialysis treatment for renal failure patients. With further research and overcoming the associated challenges, hemodiafiltration may become the new standard of care for dialysis patients, providing improved outcomes and quality of life.