Haemodiafiltration increases longevity compared with haemodialysis, but does it improve patient satisfaction?

Due to the many variables that may impact health-related quality of life in both haemodiafiltration and haemodialysis, investigators of  the CONVINCE trial were also interested in measuring patient-reported outcomes (PROs). Overall, patients described a significant deterioration of health. Differences in PROs between haemodiafiltration and haemodialysis have not yet been reported.

The CONVINCE trial (NTR7138) was a multinational, open-label, randomised-controlled clinical trial that assessed the survival of patients with kidney failure at 30 months following high-dose haemodiafiltration compared with high-flux haemodialysis. Inclusion criteria for CONVINCE included renal replacement therapy (RRT) for more than 2.5 years. The study consisted of 677 patients receiving haemodialysis and 683 patients receiving haemodiafiltration. In the trial, haemodiafiltration showed a reduced risk of death compared with haemodialysis (HR 0.77; 95% CI 0.65–0.93) [1].

A further important consideration when comparing treatments is patients’ feelings of well-being, both physically and emotionally. The presented study aimed to assess PROs in the CONVINCE cohort, using the Patient-Reported Outcome Measurement Information System (PROMIS) [2]. PROMIS examines 8 domains: social participation, depression, anxiety, cognitive function, physical function, pain interference, sleep disturbance, and fatigue. PRO assessments were collected for 84% of the participants. Assessments were taken before randomisation, and then every 3 months for 3 years. This amounted to 10,681 total analysable questionnaires. The omnibus test was used to determine significance.

Overall, all domains of PROMIS revealed a significant deterioration of health throughout the study. The domains with the lowest scores were physical function with a mean T-score ± SD of 44.0 ± 9.9, sleep (49.0 ± 9.3), and anxiety (49.4 ± 9.3). Differences between the haemodiafiltration and haemodialysis groups will be reported in an upcoming paper.

1. Blankestijn PJ, et al. N Engl J Med 2023; Aug 24. DOI: 10.1056/nejmoa2304820
2. Rose M, et al. Patient-Reported Health Status of Adults with Kidney Failure Receiving Hemodiafiltration vs. Hemodialysis: Results from the CONVINCE Randomized Controlled Clinical Trial. TH-PO1134, ASN Kidney Week 2023, 2–5 November, Philadelphia, PA, USA.

 

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Posted on 28 November, 202328 November, 2023