Controversy on the CONVINCE study findings: the PRO take

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Clinical Trials

Background:

• End-stage kidney disease (ESKD) management relies on renal replacement therapies.
• High-flux hemodialysis is a conventional treatment, but its impact on mortality is debated.
• Improving survival rates in ESKD patients remains a critical clinical challenge.

Purpose of the Study:

• To evaluate the efficacy of high convective volume hemodiafiltration (HCV-HDF) versus high-flux hemodialysis (HF-HD).
• To assess the impact of HCV-HDF on all-cause mortality in patients with ESKD.
• To explore potential benefits of HCV-HDF in specific patient subgroups.

Main Methods:

• The CONVINCE study was a randomized controlled trial involving 1360 ESKD patients.
• Patients were assigned to either HCV-HDF or HF-HD.
• The primary endpoint was the relative risk of all-cause mortality.

Main Results:

• HCV-HDF demonstrated a significant 23% reduction in the relative risk of all-cause mortality.
• This benefit was observed across various subgroups, including elderly, short vintage, non-diabetic, and patients without cardiac issues.
• A notable protective effect against infection, including COVID-19, was associated with HCV-HDF.

Conclusions:

• High convective volume hemodiafiltration is superior to high-flux hemodialysis in reducing all-cause mortality for ESKD patients.
• The findings support the broader adoption of HCV-HDF as a preferred renal replacement therapy.
• Further research is warranted to explore cost-effectiveness and optimal patient selection.