Hemodiafiltration associated with better quality of life than hemodialysis
Click Here to Manage Email Alerts
Key takeaways:
- Adults with chronic kidney disease reported better quality of life with 30 months of high-dose hemodiafiltration vs. conventional high-flux dialysis.
- Cognitive decline was twice as fast for those on dialysis.
Adults with chronic kidney disease managed with hemodiafiltration reported less drop in health-related of quality of life, particularly in cognitive decline, compared with those using hemodialysis, according to data from the CONVINCE trial.
As Healio previously reported, in the open-label, randomized controlled CONVINCE trial, the primary outcome of death from any cause was 23% lower for patients using high-dose hemodiafiltration compared with high-flux hemodialysis.
Findings on the secondary outcome, health-related quality of life, were published in Kidney International.
“Next to mortality and morbidity, physical and psychosocial aspects of perceived health ... are important outcomes for patients with kidney disease,” Matthias Rose, MD, PhD, professor and chair of the department of psychosomatic medicine at Charité - Universitätsmedizin in Berlin, Germany, and colleagues wrote. “As enhancing the health-related quality of life of the patients is a primary objective of kidney replacement therapy, a critical inquiry arises as to whether distinct kidney replacement treatment modalities, in particular hemodiafiltration vs. conventional hemodialysis, differentially affect patient health.”
CONVINCE was conducted from November 2018 to April 2021 at 61 centers in eight European countries. Researchers randomly assigned adults (mean age, 62 years; 63% men) with CKD treated with high-flux hemodialysis for at least 3 months to either continue that therapy (n = 677) or convert to high-dose hemodiafiltration (n = 683). At baseline and then quarterly for a median of 30 months, 84% of the participants completed short forms from the Patient-Reported Outcome Measurement Information System-29 v2.0 profile that assessed the following health domains: physical function, fatigue, sleep disturbance, depression, anxiety, pain interference, ability to participate in social roles and activities, pain intensity and cognitive function.
At baseline, scores for fatigue, sleep disturbance, anxiety, depression, pain interference and ability to participate in social roles, as well as summary mental health scores, were similar to those of the general population for both groups of participants. In contrast, physical health scores were 0.5 standard deviation lower for the patients with kidney disease.
Participants in both groups experienced diminishing health-related quality of life in all studied domains over time, but declines were slower for the hemodiafiltration group according to the researchers.
At 30 months, overall scores were significantly better for the hemodiafiltration group compared with the hemodialysis group. With regard to specific domains, drops in scores, indicating worse quality of life, were smaller for the hemodiafiltration group than for the hemodialysis group: cognitive function (–0.95; 95% CI, –2.23 to 0.34 vs. –3.9; 95% CI, –5.28 to –2.52), social participation (–1.97; 95% CI, –3 to –0.93 vs. –3.62; 95% CI, –4.68 to –2.56) and physical function (–2.7; 95% CI, –3.73 to –1.67 vs. –3.9; 95% CI, –4.96 to –2.85). Overall physical health and cognitive function scores decreased by an estimated –1.19 and –0.49 units per year, respectively, for the hemodiafiltration group and by –1.65 and –1.05 units per year, respectively, for the hemodialysis group, according to the researchers.
“Hemodiafiltration treatment sustained health-related quality of life more effectively” the researchers wrote. “Patients reported a similar trajectory, but their perceived health deterioration was significantly slower for physical function, cognitive function, as well as their ability to participate in social role activities. Observed scores in all domains were more favorable for the hemodiafiltration group early on, with score differences between groups increasing over time. ... Overall, we observed a consistent pattern of positive effects for patients receiving hemodiafiltration treatment.”
Collapse
Click Here to Manage Email Alerts