High-dose hemodiafiltration (HDF) compared with hemodialysis slows the decline in several domains of health-related quality of life (HRQoL) in patients with end stage chronic kidney disease, reports a paper in Kidney International.
The researchers present data from the CONVINCE (the comparison of high-dose HDF with high-flux HD [hemodialysis]) trial, a randomized, open-label clinical trial comparing the outcomes of high-dose HDF versus high-flux hemodialysis. In a study from last year, a significant reduction in all-cause mortality among patients assigned to HDF (17.3%) compared with those receiving hemodialysis (21.9%) was found.
The secondary analysis included state-of-the-art HRQoL assessment, drawn from the Patient-Reported Outcomes Measurement Information System. Responses were received from 541 patients with dialysis-dependent chronic kidney disease. Patients were observed for a median of 30 months.
The HDF and hemodialysis groups both showed a “small to modest” deterioration in HRQoL. Across all eight domains, patients receiving HDF had a slower rate of decline in HRQoL. The strongest effect was noted in the domain of cognitive function, with a score difference of 2.95. Social participation and physical function showed score differences of 1.65 and 1.20, respectively.
Estimated change in overall physical health was −1.19 with HDF versus −1.65 with hemodialysis. High-dose HDF was associated with a slower decline in cognitive function compared with hemodialysis: −0.49 versus −1.05. Trends in anxiety and depression scores were similar between groups.
Previous studies of the HRQoL effects of HDF versus hemodialysis have yielded inconclusive results. This secondary analysis of CONVINCE data finds “a consistent pattern of positive effects” for patients assigned to HDF. The findings suggest that HDF slows the rate of decline in physical and social components of HRQoL—particularly on cognitive function—and that these effects become more prominent over time. The authors discuss their findings in light of the previous mixed results on HRQoL outcomes with HDF [Rose M, et al. The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration. Kidney Int, published online July 30, 2024. doi: 10.1016/j.kint.2024.07.014].
