THE CONVINCE trial has recently revealed promising results for patients undergoing high-dose haemodiafiltration (HDF) over high-flux haemodialysis (HD). Led by Matthias Rose, Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin, Germany, this trial aimed to identify the best possible dialysis treatment by comparing high-dose HDF versus conventional high-flux HD treatment.
The primary analysis demonstrated a clear survival benefit for patients receiving HDF. A secondheary objective of the study focused on health-related quality of life (HRQoL), which was assessed in eight domains: physical function, cognitive function, fatigue, sleep disturbance, anxiety, depression, pain interference, and social participation. These domains were measured using the Patient-Reported Outcome Measurement Information System (PROMIS) before randomisation and every three months thereafter.
In total, 1,360 adults with dialysis-dependent chronic kidney disease participated in the trial. Patients were randomly assigned to either the HDF or HD group, with an 84% response rate to the questionnaires. Both groups experienced a continuous decline in all HRQoL domains, but the deterioration was notably slower in the HDF group.
After a median observation period of 30 months, the most significant differences were seen in cognitive function. HDF patients showed a decline of -0.95 units, while HD patients experienced a steeper decline of -3.90 units. Additionally, the HDF group showed a slower decline in physical function, pain interference, and social participation. Overall, the physical health summary score for HDF patients decreased by -0.46 units per year more slowly than for HD patients.
The CONVINCE trial highlights the dual benefit of high-dose HDF, showing both improved survival and a moderate positive impact on quality of life, particularly in cognitive function.
Helena Bradbury, EMJ
Reference
Rose M et al. The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration. Kidney Int. 2024.
