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Rose M, Fischer FH, Liegl G, Strippoli GFM, Hockham C, Vernooij RWM, Barth C, Canaud B, Covic A, Cromm K, Cucui AM, Davenport A, Fischer KI, Hegbrant J, Jaha H, Schappert A, Török M, Woodward M, Bots ML, Blankestijn PJ. The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration. Kidney Int 2024:S0085-2538(24)00534-9. [PMID: 39089577 DOI: 10.1016/j.kint.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024]
Abstract
In the CONVINCE trial, the primary analysis demonstrated a survival benefit for patients receiving high-dose hemodiafiltration (HDF) as compared with high-flux hemodialysis (HD). A secondary objective was to evaluate effects on health-related quality of life (HRQoL); assessed in eight domains (physical function, cognitive function, fatigue, sleep disturbance, anxiety, depression, pain interference, social participation) applying instruments from the Patient-Reported Outcome Measurement Information System (PROMIS) before randomization and every three months thereafter. In total 1360 adults with dialysis-dependent chronic kidney disease, eligible to receive high-flux HDF (23 liters or more), were randomized (1:1); 84% response rate to all questionnaires. Both groups reported a continuous deterioration in all HRQoL domains. Overall, raw score changes from baseline were more favorable in the HDF group, resulting in a significant omnibus test after a median observation period of 30 months. Most relevant single raw score differences were reported for cognitive function. Patients receiving HDF reported a decline of -0.95 units (95% confidence interval - 2.23 to +0.34) whereas HD treated patients declined by -3.90 units (-5.28 to - 2.52). A joint model, adjusted for mortality differences, utilizing all quarterly assessments, identified a significantly slower HRQoL decline in physical function, cognitive function, pain interference, and social participation for the HDF group. Their physical health summary score declined -0.46 units/year slower compared to the HD group. Thus, the CONVINCE trial showed a beneficial effect of high-dose hemodiafiltration for survival as well as a moderate positive effect on patients' quality of life, most pronounced with respect to their cognitive function. REGISTRATION: NTR7138 on the International Clinical Trials Registry Platform.
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Affiliation(s)
- Matthias Rose
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; German Center for Mental Health (DZPG, Germany
| | - Felix H Fischer
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; German Center for Mental Health (DZPG, Germany.
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany
| | - Giovanni F M Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy; School of Public Health, University of Sydney, Sydney, Australia
| | - Carina Hockham
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Claudia Barth
- B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany
| | - Bernard Canaud
- Montpellier University, School of Medicine, Montpellier, France
| | - Adrian Covic
- Department of Nephrology, University of Medicine "Grigore T. Popa" Iasi and Fresenius Nephrocare, Romania
| | - Krister Cromm
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - Andrea M Cucui
- Fresenius Nephrocare Dialysis Center, Bucharest, Romania
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, Division of Medicine, University College London, London, UK
| | - Kathrin I Fischer
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany
| | - Jörgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hanna Jaha
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany
| | - Anna Schappert
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Center for Patient Centered Outcomes Research, Charité Universitätsmedizin Berlin (CPCOR), Berlin, Germany; German Center for Mental Health (DZPG, Germany
| | | | - Mark Woodward
- School of Public Health, University of Sydney, Sydney, Australia; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Ethier I, Nevis I, Suri RS. Quality of Life and Hemodynamic Effects of Switching From Hemodialysis to Hemodiafiltration: A Canadian Controlled Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211057717. [PMID: 34804556 PMCID: PMC8600559 DOI: 10.1177/20543581211057717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Recent randomized clinical trials have demonstrated beneficial effects of
hemodiafiltration (HDF) compared with hemodialysis (HD) on mortality and
hemodynamic stability. Data on quality of life in HDF compared with HD is
limited. Objective: This study aimed to determine whether patients receiving HD experience
improvements in quality of life, hemodynamic and laboratory parameters after
switching to HDF. Design: Observational controlled cohort study. Setting & Patients: Adult patients receiving maintenance dialysis were followed for 3 months both
before and after transfer to a new unit, where they received HDF. Prior to
transfer, control patients were already treated by HDF. Methods: Quality of life at baseline and follow-up was measured using the validated
minutes to recovery (MR) question. Dialysis data were collected for 3
consecutive sessions monthly; laboratory values were collected monthly.
Wilcoxon signed rank test and repeated measures analysis of covariance were
used to evaluate pre/post transfer changes and quantile regression to
identify predictors of change in recovery time. Results: Of 227 patients, 82 died, were transplanted, were hospitalized or did not
transfer, leaving 123 subjects and 22 controls for analysis. MR did not
improve with switching to HDF, although patients with MR > 60 min before
transfer experienced a significant decrease in their MR, compared with
controls. There was no improvement in intradialytic hypotension with HDF.
There were no differences in laboratory values before vs after switch. Limitations: Nonrandomized single-center study, including only small numbers of patients
and covering a short follow-up period; hemodynamic values only evaluated
over 1 week per month; residual kidney function not recorded. Conclusions: In this Canadian experience of HDF, patients remained stable with respect to
several laboratory and dialysis related parameters. Switch to HDF was
associated with substantially reduced recovery time in patients with MR >
60 minutes at baseline.
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Affiliation(s)
- Isabelle Ethier
- Department of Medicine, Section of Nephrology, Centre Hospitalier de l'Université de Montréal, QC, Canada.,Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, QC, Canada
| | - Immaculate Nevis
- Goodman School of Business, Brock University, St. Catharines, ON, Canada
| | - Rita S Suri
- Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, QC, Canada.,Department of Medicine, Section of Nephrology, McGill University Health Centre, Montreal, QC, Canada
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Kang SH, Do JY, Lee SY, Kim JC. Effect of dialysis modality on frailty phenotype, disability, and health-related quality of life in maintenance dialysis patients. PLoS One 2017; 12:e0176814. [PMID: 28467472 PMCID: PMC5415130 DOI: 10.1371/journal.pone.0176814] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Health-related quality of life (HRQoL) surveys are needed to evaluate regional and ethnic specificies. The aim of the present study was to evaluate the differences in HRQoL, frailty, and disability according to dialysis modality in the Korean population. Patients and methods We enrolled relatively stable maintenance dialysis patients. A total of 1,616 patients were recruited into our study. The demographic and laboratory data collected at enrollment included age, sex, comorbidities, frailty, disability, and HRQoL scales. Results A total of 1,250 and 366 participants underwent hemodialysis (HD) and peritoneal dialysis (PD), respectively. The numbers of participants with pre-frailty and frailty were 578 (46.2%) and 422 (33.8%) in HD patients, and 165 (45.1%) and 137 (37.4%) in PD patients, respectively (P = 0.349). Participants with a disability included 195 (15.6%) HD patients and 109 (29.8%) PD patients (P < 0.001). On multivariate analysis, the mean physical component scale (PCS) and mental component scale (MCS), symptom/problems, and sleep scores were higher in HD patients than in PD patients. Cox regression analyses showed that an increased PCS in both HD and PD patients was positively associated with patient survival and first hospitalization–free survival. An increased MCS in both HD and PD patients was positively associated with first hospitalization–free survival only. Conclusion There was no significant difference in frailty between patients treated with the two dialysis modalities; however, disability was more common in PD patients than in HD patients. The MCS and PCS were more favorable in HD patients than in PD patients. Symptom/problems, sleep, quality of social interaction, and social support were more favorable in HD patients than in PD patients; however, patient satisfaction and dialysis staff encouragement were more favorable in PD patients than in HD patients.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - So-Young Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
- * E-mail:
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