Hemodiafiltration does not prevent neuropathy progression more effectively than dialysis
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Hemodiafiltration was not more effective than high-flux hemodialysis for reducing the progression of neuropathy in a cohort of 124 patients randomized to one of the two treatments for 48 months.
“Hemodiafiltration did not alter the progression of neuropathy, measured using a gold standard assessment of neuropathy, in a cohort of hemodialysis recipients with predominantly minor neuropathy, without irreversible damage, and therefore at the optimal timepoint for intervention,” Amy Kang, MBBS, of the University of New South Wales and the George Institute for Global Health, and colleagues wrote. “Our study also highlights the under-recognition of neuropathy even in people receiving hemodialysis therapy. In our cohort, only 15 (12%) self-reported a diagnosis of neuropathy at baseline, despite a high prevalence of neuropathy; 91 (73%) met the diagnostic threshold for neuropathy and 38 (31%) had moderate to severe neuropathy.”
Using the mean change in the yearly modified Total Neuropathy Score (mTNS) from baseline as the primary outcome, Kang and colleagues observed worsening scores in both groups (increases in mTNS of 1.7 for those on hemodiafiltration vs. 1.2 for those on hemodialysis, findings which indicated “no difference” between therapies, according to the researchers).
Despite the lack of effect on neuropathy progression, there was greater middle molecule clearance in the hemodiafiltration arm, the researchers noted.
Regarding safety, researchers observed no difference in survival (HR = 1.24) between groups, as well as no difference in access events or time to access failure. Participants in both groups also had similar rates of adverse events.
“Participants were followed for 4 years, a sufficiently long period to detect any meaningful impact of hemodiafiltration on neuropathy progression [and] hemodiafiltration was delivered according to best practice with adequate biochemical clearances and with an average convection volume of 24.7L,” Kang and colleagues wrote.
“FINESSE is the first randomized trial to investigate whether hemodiafiltration improves neuropathy over hemodialysis and the largest and longest trial in neuropathy in people with kidney disease. The lack of effect was consistent across subgroups (gender, access type, diabetes status, dialysis vintage and neuropathy severity).”
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