Why should we focus on high-volume hemodiafiltration?

Shin, Sug-Kyun; Jo, Young-Il

doi:10.23876/j.krcp.21.268

Cited by 3 publications

(2 citation statements)

References 62 publications

(123 reference statements)

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“…Esse aspecto foi recentemente revisado de forma abrangente em diversos artigos e não será discutido aqui. Recomendamos que os leitores interessados consultem artigos de revisão publicados anteriormente 27,28 . Em resumo, é possível reconhecer que os benefícios da hemodiafiltração abrangem um amplo espectro de efeitos biológicos e clínicos, que podem ser classificados em duas categorias principais: efeitos diretos e indiretos 28 .…”

Section: Quais São Os Mecanismos Que Sustentam Os Benefícios Clínicos...unclassified

Controvérsia sobre os achados do estudo CONVINCE: a perspectiva PRO

Canaud,

Blankestijn

2024

Braz. J. Nephrol.

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RESUMO O estudo CONVINCE, publicado recentemente no New England Journal of Medicine, revela uma redução inovadora de 23% no risco relativo de mortalidade por todas as causas entre pacientes renais em estágio terminal submetidos à hemodiafiltração de alto volume de convecção. Esse achado significativo desafia o uso convencional da hemodiálise de alto fluxo e oferece esperança de melhoria dos desfechos em pacientes com doença renal crônica. Embora algumas controvérsias cerquem os achados do estudo, incluindo preocupações sobre a generalização e as causas de óbito, é essencial reconhecer o desenho do estudo e seus principais desfechos. O estudo CONVINCE, parte do projeto HORIZON 2020, inscreveu 1.360 pacientes e demonstrou a superioridade da hemodiafiltração na redução da mortalidade por todas as causas em geral, bem como em subgrupos específicos de pacientes (idosos, HD de curta duração, não diabéticos e aqueles sem problemas cardíacos). Curiosamente, demonstrou-se que a hemodiafiltração teve um efeito protetor contra infecções, incluindo a COVID-19. Pesquisas futuras abordarão sustentabilidade, efeitos de escalonamento da dose, identificação de subgrupos especialmente propensos a se beneficiar e a relação custo-benefício. No entanto, por ora, os achados apoiam fortemente uma adoção mais ampla da hemodiafiltração na terapia renal substitutiva, marcando um avanço significativo na área.

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Section: Quais São Os Mecanismos Que Sustentam Os Benefícios Clínicos...unclassified

Controvérsia sobre os achados do estudo CONVINCE: a perspectiva PRO

Canaud,

Blankestijn

2024

Braz. J. Nephrol.

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“…This aspect has recently been comprehensively reviewed in several articles and will not be discussed here. We refer interested readers to previously published review articles 27 , 28 . In brief, one can recognize that the benefits of hemodiafiltration encompass a broad spectrum of biological and clinical effects, which can be categorized into two main categories: direct and indirect effects 28 .…”

Section: What Are the Mechanisms That Support Clinical Benefits Of Co...mentioning

confidence: 99%

Controversy on the CONVINCE study findings: the PRO take

Canaud,

Blankestijn

2024

Braz. J. Nephrol.

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The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study’s findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study’s design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field.

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Efficacy of medium molecular weight toxin clearance in manual mixed online hemodiafiltration vs. pre- and post-dilution online hemodiafiltration and conventional hemodialysis: A crossover observational study

Mavromatidis,

Kalogiannidou,

Passadakis

et al. 2024

Ukr. J. Nephrol. Dial.

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The effectiveness of various hemodiafiltration (HDF) modes in removing different toxins is not fully understood. The present study aimed to compare the efficacy of manual mixed online HDF with pre-dilution online HDF, post-dilution online HDF, and conventional hemodialysis in clearing medium molecular weight toxins. Methods. This single-center, crossover observational study included 11 patients (7 males, 4 females) aged 48-85 years (mean age 65.2±11.7) with a dialysis vintage of 24-455 months (mean duration 126±123 months), including 10-29 months (mean duration 19.5±6.4) on HDF. The study focused on the removal of two medium molecular weight molecules: beta 2-microglobulin and the larger prolactin. The effectiveness of various dialysis modes was evaluated in single sessions for each patient, including pre-dilution online HDF (Group A), post-dilution online HDF (Group B), a mixed dilution model with post-dilution during the first half of the session and pre-dilution during the second half (Group C), and conventional hemodialysis (Group D). Results. A statistically significant difference in the reduction of serum beta 2-microglobulin levels was observed in Group B compared to Group A (70.6±3.1% vs. 64.4±2.7%, p<0.0001) and Group C (70.6±3.1% vs. 65.9±4.9%, p<0.001), with no significant difference between Groups A and C (p=NS). For serum prolactin levels, the greatest reduction was noted in Group B, with significant differences compared to Group A (52.5±8.9% vs. 36.2±9.5%, p<0.001) and Group C (52.5±8.9% vs. 46.9±5.2%, p=0.03). Additionally, Group C showed a significant difference compared to Group A (46.9±5.2% vs. 36.2±9.5%, p<0.005). Conclusions. Post-dilution HDF is the most effective mode for removing beta 2-microglobulin and prolactin. Mixed dilution HDF also shows significant efficacy, surpassing pre-dilution HDF in toxin clearance. These findings highlight the advantage of post-dilution techniques in managing medium molecular weight toxins. Further research is needed to explore these results in greater detail and to confirm their clinical implications.

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Why should we focus on high-volume hemodiafiltration?

Cited by 3 publications

References 62 publications

Controvérsia sobre os achados do estudo CONVINCE: a perspectiva PRO

Controvérsia sobre os achados do estudo CONVINCE: a perspectiva PRO

Controversy on the CONVINCE study findings: the PRO take

Efficacy of medium molecular weight toxin clearance in manual mixed online hemodiafiltration vs. pre- and post-dilution online hemodiafiltration and conventional hemodialysis: A crossover observational study

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