Emily J See1, James Hedley2, John W M Agar3, Carmel M Hawley4,5,6, David W Johnson4,5,6, Patrick J Kelly2, Vincent W Lee7,8, Kathy Mac7, Kevan R Polkinghorne1,9,10, Kannaiyan S Rabindranath11, Kamal Sud8,12, Angela C Webster2,7. 1. Department of Nephrology, Monash Health, Clayton, VIC, Australia. 2. Sydney School of Public Health and Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 3. Department of Nephrology, University Hospital Geelong, Geelong, VIC, Australia. 4. Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia. 5. Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, QLD, Australia. 6. Translational Research Institute, Brisbane, QLD, Australia. 7. Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia. 8. Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 9. Department of Medicine, Monash University, Clayton, VIC, Australia. 10. Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia. 11. Department of Nephrology, Waikato District Hospital, Hamilton, New Zealand. 12. Department of Renal Medicine, Nepean Hospital, Kingswood, NSW, Australia.
Abstract
Background: It is unclear if haemodiafiltration improves patient survival compared with standard haemodialysis. Observational studies have tended to show benefit with haemodiafiltration, while meta-analyses have not provided definitive proof of superiority. Methods: Using data from the Australia and New Zealand Dialysis and Transplant Registry, this binational inception cohort study compared all adult patients who commenced haemodialysis in Australia and New Zealand between 2000 and 2014. The primary outcome was all-cause mortality. Cardiovascular mortality was the secondary outcome. Outcomes were measured from the first haemodialysis treatment and were examined using multivariable Cox regression analyses. Patients were censored at permanent discontinuation of haemodialysis or at 31 December 2014. Analyses were stratified by country. Results: The study included 26 961 patients (4110 haemodiafiltration, 22 851 standard haemodialysis; 22 774 Australia, 4187 New Zealand) with a median follow-up of 5.31 (interquartile range 2.87-8.36) years. Median age was 62 years, 61% were male, 71% were Caucasian. Compared with standard haemodialysis, haemodiafiltration was associated with a significantly lower risk of all-cause mortality [adjusted hazard ratio (HR) for Australia 0.79, 95% confidence interval (95% CI) 0.72-0.87; adjusted HR for New Zealand 0.88, 95% CI 0.78-1.00]. In Australian patients, there was also an association between haemodiafiltration and reduced cardiovascular mortality (adjusted HR 0.78, 95% CI 0.64-0.95). Conclusion: Haemodiafiltration was associated with superior survival across patient subgroups of age, sex and comorbidity.
Background: It is unclear if haemodiafiltration improves patient survival compared with standard haemodialysis. Observational studies have tended to show benefit with haemodiafiltration, while meta-analyses have not provided definitive proof of superiority. Methods: Using data from the Australia and New Zealand Dialysis and Transplant Registry, this binational inception cohort study compared all adult patients who commenced haemodialysis in Australia and New Zealand between 2000 and 2014. The primary outcome was all-cause mortality. Cardiovascular mortality was the secondary outcome. Outcomes were measured from the first haemodialysis treatment and were examined using multivariable Cox regression analyses. Patients were censored at permanent discontinuation of haemodialysis or at 31 December 2014. Analyses were stratified by country. Results: The study included 26 961 patients (4110 haemodiafiltration, 22 851 standard haemodialysis; 22 774 Australia, 4187 New Zealand) with a median follow-up of 5.31 (interquartile range 2.87-8.36) years. Median age was 62 years, 61% were male, 71% were Caucasian. Compared with standard haemodialysis, haemodiafiltration was associated with a significantly lower risk of all-cause mortality [adjusted hazard ratio (HR) for Australia 0.79, 95% confidence interval (95% CI) 0.72-0.87; adjusted HR for New Zealand 0.88, 95% CI 0.78-1.00]. In Australian patients, there was also an association between haemodiafiltration and reduced cardiovascular mortality (adjusted HR 0.78, 95% CI 0.64-0.95). Conclusion: Haemodiafiltration was associated with superior survival across patient subgroups of age, sex and comorbidity.