Abstract
Abstract Background and Aims The CONVINCE trial and others studies, demonstrates that high-dose hemodiafiltration offers a survival advantage and benefits in reducing cardiovascular complications for patients in high-flux hemodiafiltration group compared to hemodialysis. Method We compared the outcomes of hemodialysis and hemodiafiltration using real-world data. We conducted an analysis on a cohort of patients who underwent hemodiafiltration therapy (HDF) at a single center, NefroStar Clinics from 28/06/2021 to 30/05/2023. The results obtained were then compared with data from patients receiving hemodialysis (HD) therapy within the Brazilian Public Health System (SUS). Baseline data, type of access for dialysis and adequacy tests obtained through the average of monthly tests were collected. The HDF data were obtained through automatic extraction of electronic medical records and the HD data were obtained by Datasus. The primary outcome was mortality from any cause. Results 85 patients undergoing hemodiafiltration were compared with 149,372 patients receiving hemodialysis through the Brazilian Public Health System (SUS). Using a 2:1 propensity score, we compared the 170 best-match HD patients along with 85 HDF patients. The percentage of vascular access and male sex were similar in both groups. The mean age of HDF and HD patients was 54 [41-67] and 58 [46-68] years, p=0.054, respectively. The adequacy tests show higher hemoglobin values and mores PTH values in the HDF group. In the Cox analysis, HDF therapy showed a reduced risk of mortality with an HR of 0.29 [0.11 – 0.77]. The propensity score analysis showed a HR of 0.32 [95% CI: 0.11 – 0.91]. This analysis was adjusted for age, type of access, KT/v, hemoglobin, and phosphorus. The Kaplan-Meier analysis showed respective survival rates for HDF and HD at the end of one year, 92.1% and 79.9%, p<0.001. Conclusion These results suggest high flux hemodiafiltration had survival advantages over hemodialysis in real word scenario.
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