Major step forward reduces mortality in kidney failure patients: Clinical trial (Hemodiafiltration option already in US dialysis machines would reduce deaths 23%)

Medical Xpress / University College London / New England Journal of Medicine ^ | June 16, 2023 | Peter J. Blankestijn et al

[ConservativeMind]

Mortality in patients with kidney failure has been found to be 23% lower among those treated with high dose hemodiafiltration compared to those treated with high flux hemodialysis, according to research.

Chronic kidney disease affects an estimated 830 million people. When kidneys can no longer do their job, dialysis is used to clean the blood by removing waste products.

Hemodialysis is the most common form of dialysis used in the treatment for kidney failure. Though it has improved over the years, it is not good at removing larger molecules from the blood. Hemodiafiltration is a newer technology that can remove larger molecules, but it is not suitable for all patients due to the fact it requires a higher blood flow rate to be effective. Previous studies have failed to conclusively prove that one method is more effective than the other.

A total of 1,360 patients were randomized, with 683 treated with high-dose hemodiafiltration and 677 treated with high-flux hemodialysis three times a week.

During a median follow-up of 30 months, all-cause mortality was 21.9% among those treated with high-flux hemodialysis, compared to 17.3% for those treated with high-volume hemodiafiltration. This 4.6% difference represents a 23% reduction in the risk of death.

Professor Peter Blankestijn said, "Our results show clear survival benefits for using hemodiafiltration over hemodialysis to treat kidney failure, akin to a 23% reduction in all-cause mortality. My hope is that hemodiafiltration can become the new standard."

While hemodialysis is standard treatment in most countries, hemodiafiltration is less widely used in some places and is not used at all in places like the US. Most modern dialysis machines can perform either method, which would make a switch to hemodiafiltration relatively easy.

Professor Andrew Davenport said, "I would say that this is the first major step forward in many years."

[ConservativeMind]

Folks, this is the kicker, for something that would reduce death by 23% in the US:

“While hemodialysis is standard treatment in most countries, hemodiafiltration is less widely used in some places and is not used at all in places like the US. Most modern dialysis machines can perform either method, which would make a switch to hemodiafiltration relatively easy.”

It’s a “relatively easy” setting change, and you aren’t getting it.

[ConservativeMind]

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[Salvavida]

Interesting. I thought death had a 100% success rate.

[icclearly]

Your facts are misleading.

Why use the intrusive and debilitating hemodialysis at all when peritoneal dialysis shows a 48% improved mortality rate, as noted by the NIH here

I know. I've done both.

[ConservativeMind]

It looks like the United States does not allow Hemodiafiltration outside of ICUs, so you may not have had this therapy, at all:

Online Hemodiafiltration

Hemodiafiltration (HDF) combines both hemofiltration (HF) and HD in a single procedure. Whereas in the United States HDF is mostly performed in intensive care units, many other countries have adapted this modality for outpatient therapy, mostly known as “online” HDF. Online HDF, where replacement fluid is prepared from ultrapure dialysate, can be performed safely thanks to recent technologic advances; however, in some countries, including the United States, government restrictions prohibit the use of online HDF.

https://www.sciencedirect.com/topics/medicine-and-dentistry/hemodiafiltration

[icclearly]

It looks like the United States does not allow Hemodiafiltration outside of ICUs, so you may not have had this therapy, at all...

I'm not sure you know what you're talking about.

Hemodialysis (HD) is dialysis performed in ICUs AND in dialysis treatment centers. Of the 600,000 patients on dialysis in this country, probably 99% are treated either at home or in a treatment center -- not in ICUs. Approximately 90% of dialysis patients are on HD, with the remaining 10% on peritoneal dialysis (PD), which is treated at home.

Hemofiltration and hemodiafiltration are simply two different types of HD. According to your comment, hemodiafiltration reduces deaths by 23%. That's 23% for the extremely, extremely small portion of patients that are dialyzed in ICUs.

So, the real payoff comes for those who skip hemodialysis altogether and move to peritoneal dialysis, which reduces mortality by 48%!

Just trying to provide the reality -- not the hype.