Intermittent infusion hemodiafiltration is associated with improved survival compared to hemodialysis

Abstract

Abstract Background Approximately 16.4% of patients on hemodialysis (HD) in Japan are treated with intermittent infusion hemodiafiltration (I-HDF). However, large-scale data on clinical outcomes with this modality are lacking. This study aimed to compare the outcomes of I-HDF with those of conventional HD. Methods A cohort study was conducted using the Japanese Society for Dialysis Therapy Renal Data Registry database from December 31, 2017 to December 31, 2019. The subjects were 210,574 patients on maintenance HD. The exposure of interest was I-HDF treatment versus conventional HD. The I-HDF group was divided into two subgroups based on substitution: low-volume (< 1.2 L per session) and high-volume (≥ 1.2 L per session). Outcomes included 2-year all-cause and cardiovascular mortality. The data were analyzed using Cox regression models after adjusting for potential confounders. Results I-HDF was associated with improved all-cause mortality compared to HD (hazard ratio: 0.94, 95% confidence interval: 0.90–0.99) after adjusting for all covariates. However, there was no significant difference in cardiovascular mortality between the two groups. In patients treated with I-HDF, the high-volume I-HDF group had improved all-cause and cardiovascular mortality compared to low-volume I-HDF or HD groups. Propensity score matching analysis revealed that the high-volume I-HDF group had better survival rates than the HD group. Conclusions This observational study suggests that I-HDF, especially with high- volumes substitution, may improve all-cause and cardiovascular mortality. However, to establish a causal relationship and further evaluate the efficacy of I-HDF in improving outcomes and reducing cardiovascular events in patients on dialysis, randomized controlled trials are warranted. Trial registration UMIN000018641.