#3210 Health status in different subgroups of people receiving hemodiafiltration versus hemodialysis for renal replacement therapy: a subgroup analysis of the CONVINCE randomized controlled trial

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Abstract Background and Aims The CONVINCE randomized trial found a slower decline in self-reported health status in people receiving hemodiafiltration versus hemodialysis for renal replacement therapy, particular improvements were seen in physical and cognitive function, pain interference and social participation. There is clinical interest in whether these benefits of hemodiafiltration are modified by age, sex, time on dialysis, diabetes and cardiovascular disease, and type of vascular access. Method The CONVINCE trial data was used to perform prespecified subgroup analyses looking at the comparative effects of hemodiafiltration versus hemodialysis on self-reported health status (Physical Function, Fatigue, Pain Interference, Sleep Disturbance, Anxiety, Cognitive Function, Depression, Ability to Participate in Social Roles and Activities) by the following subgroups: age (>65, 50–65, <50 years), sex (male/female), time on dialysis (>5, 2–5, <2 years), diabetes (yes/no) and cardiovascular disease (yes/no), and type of vascular access (catheter/graft vs arteriovenous fistula). Self-reported health status data was available every 3 months over the course of the trial. We tested subgroup interaction in a longitudinal linear mixed model. Results Of 1360 patients randomized in CONVINCE, health status data were available for 1211 patients (89%). The effect of hemodiafiltration on sleep disturbance was significantly better in people with arteriovenous fistula as compared to those with catheters/grafts (p = 0.026). People who had been on dialysis for more than 5 years had better physical function when randomized to hemodiafiltration (p = 0.028). Being on hemodiafiltration had a stronger effect on pain interference in people who were <50 years (p = 0.044) and the effects on cognitive function were better in people who had no history of cardiovascular disease (p = 0.048) (see Fig. 1). Conclusion The CONVINCE study found significant effects of high-dose hemodiafiltration on some domains of health status compared to high flux hemodialysis. These benefits appear to differ slightly between patient subgroups, which could be simply the results of multiple statistical comparisons and underpowered sample, but also of relevance to be further explored in pooled analyses of randomized trials in view of clinicians’ interest on the question.

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