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Convince Hemodiafiltration Dialysis Study

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Information about end-stage kidney disease.

Background

Information about end-stage kidney disease.

End-stage kidney disease

End stage kidney disease (ESKD) ranks among the most severe chronic, non-communicable diseases world-wide.

Patient quality of life and outcomes

Despite improvements in dialysis machine and dialyzer technology, and the introduction of newer drugs, the survival of patients with kidney failure treated by dialysis remains high, and improvement in survival has not improved as much when compared to other chronic conditions, including some of the more common cancers.

In addition, many kidney dialysis patients feel tired and lack energy. This impacts on their quality of life, and the rates of self-reported depression are increased in kidney dialysis patients. 

Dialysis

Over the past decade, an alternative to standard haemodialysis (HD) has become available ‒ haemodiafiltration (HDF). HDF uses the same dialyser, and dialysis water, but differs from standard HD, as the dialysis machine takes more fluid away from the blood as it passes through the dialyser, but then replaces this fluid by returning the same amount with dialysis water, so the additional amount of fluid removed is balanced by the fluid replaced. 

HD removes water soluble toxic compounds that accumulate in patients with kidney failure mainly by diffusion, and a smaller amount by convection. HDF differs by increasing the amount removed by convection. Diffusion is very efficient at removing small molecules, but not so good at removing larger molecules, whereas convection is more efficient at removing larger molecules.

Although on one hand HDF improves the range of water-soluble toxic compounds removed, unlike the healthy kidney, neither HD nor HDF can offer selective removal of molecules, so both treatments can potentially lead to the loss of important molecules, such as vitamins and some proteins. So, although HDF increases the range of water-soluble toxic compounds removed, it could also lead to an increased loss of important molecules.

Studies on Haemodialysis & Haemodiafiltration

There have been several studies comparing HD and HDF, but many of these have been too small to be able to come to any firm conclusion as to whether HD and HDF are equivalent treatments, or one is better than the other. Statisticians have tried to combine these studies to get enough patients to compare HD and HDF, but once again these analyses have failed to demonstrate a difference. However, the studies included in these analyses often differ, so making comparisons difficult.

As such, there is current uncertainty as to whether HDF offers any benefit over standard HD, or whether treatments are equivalent, or if HD is better for patients than HDF. 

The CONVINCE study has been designed to answer whether HD or HDF offers patients a better treatment, or whether treatments are equivalent, by enrolling a large number of kidney dialysis patients, currently dialysing in Europe.

The CONVINCE study will collect information from patients about quality of life, as well as information about hospital admissions and patient survival.

Results from the CONVINCE study will be used to:

Develop best practises and new guidelines for doctors and dialysis centres on the most effective and efficient type of dialysis for patients with kidney failure.