Nephrology · 4 h ago
CONVINCE Subgroup Analysis Finds No Meaningful PRO Differences With HDF
A prespecified subgroup analysis of the CONVINCE randomized trial included 1,211 adults receiving maintenance dialysis and compared high-volume hemodiafiltration with high-flux hemodialysis. Patient-reported outcome effects were broadly consistent across clinical subgroups, with several modest, exploratory interactions that do not support selecting or excluding patients based on these outcomes.
- PRO effects were broadly consistent across prespecified subgroups.
- Several modest interactions were nominal and exploratory.
- Findings do not support subgroup-based HDF selection.
This prespecified subgroup analysis of the multicenter CONVINCE randomized trial compared high-volume post-dilution hemodiafiltration (HDF; at least 23 L per session) with high-flux hemodialysis in adults receiving maintenance dialysis. Eight PROMIS patient-reported outcome domains were assessed quarterly over a median 30-month follow-up. Analyses examined interactions with age, sex, diabetes, cardiovascular disease, dialysis vintage, vascular access type and residual urine volume. Of 1,360 randomized participants, 1,211 had baseline and follow-up assessments and were included.
Treatment effects were broadly consistent across subgroups, with no evidence of clinically meaningful heterogeneity. Adjusted analyses found nominal interactions for dialysis vintage and physical function (P=0.03), age and pain interference (P=0.02), and dialysis vintage and sleep disturbance (P=0.04). Sensitivity analyses accounting for death-related dropout reproduced two interactions and identified others involving vascular access and sleep disturbance (P=0.03), and cardiovascular disease and cognitive function (P=0.05).
The interactions were modest, not consistently seen across related domains, and unadjusted for multiple comparisons. The authors characterize them as hypothesis-generating and conclude that these findings should not guide selection or exclusion of patients for HDF based on patient-reported outcomes.
In practice
For adults receiving maintenance dialysis, this prespecified analysis does not show convincing evidence that patient-reported outcome effects of high-volume HDF versus high-flux hemodialysis differ meaningfully by the baseline characteristics examined. The observed subgroup interactions were modest, exploratory, unadjusted for multiple comparisons and not consistent across related outcome domains. These results therefore do not support selecting or excluding patients for HDF on the basis of expected patient-reported outcome differences. The analysis addresses subgroup variation, not whether HDF should replace hemodialysis generally.
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Clinical Journal of the American Society of Nephrology: Patient-Reported Outcomes with High-Volume Hemodiafiltration Versus High-Flux Hemodialysis Across Clinical Subgroups ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.