High-Target Hemodiafiltration Convective Dose Achieved in Most Patients in a 6-Month Intermediary Analysis of the CONVINCE Randomized Controlled Trial

Robin W M Vernooij; C Hockham; C Barth; B Canaud; K Cromm; A Davenport; J Hegbrant; M Rose; G F M Strippoli; M Török; M Woodward; M L Bots; P J Blankestijn

doi:10.1016/j.ekir.2023.08.004

High-Target Hemodiafiltration Convective Dose Achieved in Most Patients in a 6-Month Intermediary Analysis of the CONVINCE Randomized Controlled Trial

Kidney Int Rep. 2023 Aug 19;8(11):2276-2283. doi: 10.1016/j.ekir.2023.08.004. eCollection 2023 Nov.

Authors

Robin W M Vernooij^{1

2}, C Hockham³, C Barth⁴, B Canaud⁵, K Cromm⁶, A Davenport⁷, J Hegbrant⁸, M Rose^{9

10}, G F M Strippoli^{11

12}, M Török¹³, M Woodward^{3

14}, M L Bots², P J Blankestijn¹

Affiliations

¹ Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
³ George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
⁴ B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany.
⁵ Montpellier University, School of Medicine, Montpellier, France and Global Medical Office, FMC Deutschland, Bad Homburg, Germany.
⁶ Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany.
⁷ UCL Center for Nephrology, Royal Free Hospital, Division of Medicine, University College London, London, UK.
⁸ Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁹ Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
¹⁰ Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin Institute of Health, Berlin, Germany.
¹¹ Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy.
¹² School of Public Health, University of Sydney, Sydney, Australia.
¹³ Corporate Medical Office Diaverum, Malmö, Sweden.
¹⁴ The George Institute for Global Health, University of New South Wales, Sydney, Australia.

Abstract

Introduction: High convection volumes in hemodiafiltration (HDF) result in improved survival; however, it remains unclear whether it is achievable in all patients.

Methods: CONVINCE, a randomized controlled trial, randomized patients with end-stage kidney disease 1:1 to high-dose HDF versus high-flux hemodialysis (HD) continuation. We evaluated the proportion of patients achieving high-dose HDF target: convection volume per visit of ≥23 l (range ±1 l) at baseline, month 3, and month 6. We compared baseline characteristics in the following 2 ways: (i) patients on target for all 3 visits versus patients who missed target on ≥1 visits and (ii) patients on target for all 3 visits or missing it once versus patients who missed target on ≥2 visits.

Results: A total of 653 patients were randomized to HDF. Their mean age was 62.2 (SD 13.5) years, 36% were female, 81% had fistula vascular access, and 33% had diabetes. Across the 3 visits, 75 patients (11%), 27 patients (4%), and 11 patients (2%) missed the convection volume target once, twice, and thrice, respectively. Apart from diabetes, there were no apparent differences in patient characteristics between patients who always achieved the high-dose target (83%) and those who missed the target either once or more (17%) or twice or more (6%).

Conclusion: Achieving high-dose HDF is feasible for nearly all patients in CONVINCE and could be maintained during the 6-month follow-up period. Apart from diabetes, there were no other indications for confounding by indication on multivariable analyses that may explain the potential survival advantage for patients receiving high-dose HDF.

Keywords: baseline characteristics; convection volume; hemodiafiltration; hemodialysis; kidney failure; randomized controlled trial.